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Continuing clopidogrel during elective total hip and knee arthroplasty: assessment of bleeding risk and adverse
Adam K Jacob1, Sean P Hurley1, Sean M Loughran1
1Departments of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
Insights
Continuing clopidogrel during elective orthopedic surgery increases transfusion risk but does not significantly raise adverse cardiac events. Careful consideration is advised for perioperative clopidogrel use in total knee arthroplasty and total hip arthroplasty patients.
Area of Science:
- Orthopedic Surgery
- Cardiology
- Pharmacology
Background:
- Limited data exists on the perioperative risks of continuing clopidogrel.
- Clopidogrel is an antiplatelet medication commonly prescribed for cardiovascular conditions.
Purpose of the Study:
- To assess the risks associated with continuing clopidogrel perioperatively in patients undergoing elective orthopedic procedures.
- To evaluate the impact of perioperative clopidogrel on blood transfusion rates and adverse cardiac events in total knee arthroplasty and total hip arthroplasty patients.
Main Methods:
- Retrospective review of patients undergoing elective primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) between 2007 and 2012.
- Data collected included patient demographics, clopidogrel last dose, intraoperative blood loss, blood transfusion requirements, and 30-day adverse cardiac events (ACE).
Main Results:
- Of 142 identified patients, 24 (16.9%) continued clopidogrel perioperatively.
- Patients on clopidogrel had significantly higher rates of blood transfusion within 24 hours (31.8% vs. 7.7%; P=0.004) and during hospitalization (37.5% vs. 15.3%; P=0.02).
- No significant difference in the incidence of 30-day adverse cardiac events was observed between groups.
Conclusions:
- Perioperative continuation of clopidogrel in patients undergoing elective total hip arthroplasty or total knee arthroplasty is associated with an increased need for blood transfusions.
- The decision to continue clopidogrel during these procedures requires careful consideration due to transfusion risks, as 30-day adverse cardiac events were not significantly impacted.
Abstract:
Limited research assessing risks of continued clopidogrel perioperatively in patients undergoing elective orthopedic procedures exists. Patients that underwent elective primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) from 2007 to 2012 while taking clopidogrel at the time of surgical evaluation were retrospectively identified. Patient demographics, last dose of clopidogrel, intraoperative blood loss, blood transfusion, and presence of 30-day adverse cardiac events (ACE) were collected. Of 142 patients meeting criteria, 24 (16.9%) patients remained on clopidogrel perioperatively. Patients that continued clopidogrel were more likely to receive a blood transfusion within 24 hours of surgery (31.8% vs. 7.7%; P=0.004) and during hospitalization (37.5% vs. 15.3%; P=0.02), but the incidence of 30-day ACE was not significantly different. Continuation of clopidogrel perioperatively for elective THA or TKA should be carefully considered.
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