Uninterrupted perioperative clopidogrel and bleeding-related events after total joint arthroplasty: a case series

There is a known bleeding risk with administration of the antiplatelet drug clopidogrel, but in certain patients the likelihood of thrombosis is too high to cease its administration perioperatively. The risks of performing total joint arthroplasty in this population are unknown. An inpatient pharmacy database query identified seven patients who underwent eight hip or knee arthroplasties from 2007 to 2009 without perioperative interruption in clopidogrel administration. Bleeding-related events were recorded, including one inpatient death, one reoperation for infection, two 30-day readmissions, two antibiotic prescriptions for the incision, and blood transfusion administration during seven of eight admissions. The majority of bleeding-related events occurred following knee arthroplasty. Uninterrupted perioperative clopidogrel administration was associated with a high risk of bleeding-related events following total joint arthroplasty, particularly of the knee. Consideration should be given to delaying total joint arthroplasty until clopidogrel can safely be held in the perioperative period.