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Should clopidogrel be discontinued before laparoscopic cholecystectomy?
Katherine Anderson1, Daniel C Jupiter1, Stephen W Abernathy1
1Baylor Scott & White Health, 2401 South 31st Street, Temple, TX 76508, USA.
Insights
Continuing clopidogrel during laparoscopic cholecystectomy is safe. This antiplatelet medication did not increase blood loss, operative time, or complications in patients undergoing gallbladder surgery.
Area of Science:
- Surgical Management
- Pharmacology
- Cardiovascular Medicine
Background:
- Perioperative management of clopidogrel is controversial.
- Clopidogrel is an antiplatelet medication.
- Laparoscopic cholecystectomy is a common surgical procedure.
Purpose of the Study:
- To evaluate the safety of continuing clopidogrel during laparoscopic cholecystectomy.
- To compare outcomes between patients on clopidogrel and a control group.
Main Methods:
- Retrospective review of 100 patients undergoing laparoscopic cholecystectomy.
- Matched patients on clopidogrel with a control group.
- Compared estimated blood loss, operative time, length of stay, and 30-day morbidity.
Main Results:
- No significant differences in blood loss, operative time, length of stay, or 30-day morbidity between groups.
- Average blood loss was 50 mL in the clopidogrel group and 47 mL in the control group.
- Patient demographics and comorbidities were similar between groups.
Conclusions:
- Continuing clopidogrel during laparoscopic cholecystectomy is safe.
- The medication does not increase surgical risks.
- Perioperative management of clopidogrel can be individualized.
Background:
The perioperative management of clopidogrel remains an area of controversy.
Methods:
An institutional review board-approved retrospective review of patients undergoing a laparoscopic cholecystectomy while on clopidogrel from 2008 to 2012 was performed. These patients were then matched with a nonclopidogrel cohort based on American Society of Anesthesiologists score and emergent or elective surgery. Intraoperative estimated blood loss, operative time, length of stay, and 30-day morbidity were compared.
Results:
Thirty-six clopidogrel and 36 control patient records were analyzed. There were no significant differences in age, body mass index, sex, or incidence of coronary artery disease, diabetes, hyperlipidemia, and congestive heart failure. Estimated blood loss averaged 50 mL in the clopidogrel group and 47 mL in the control group (P = nonsignificant). There were no significant differences in operative time, 30-day morbidity, or length of stay between the 2 groups.
Conclusions:
Laparoscopic cholecystectomy performed on patients maintained on clopidogrel during the perioperative period did not produce an increase in blood loss, operative time, 30-day morbidity, or length of stay.
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