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The evaluation of clopidogrel use in perioperative general surgery patients: a prospective randomized controlled
Edward W Chu1, Artur Chernoguz1, Celia M Divino1
1Division of Genery Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1259, New York, NY 10029, USA.
Insights
Patients can safely continue clopidogrel before general surgery. This study found no increased bleeding risk when clopidogrel was maintained perioperatively, offering new guidance for cardiovascular disease management.
Area of Science:
- Cardiovascular Medicine
- Surgical Oncology
- Pharmacology
Background:
- The perioperative safety of clopidogrel, an antiplatelet medication, is not well-established.
- Current guidelines do not recommend for or against clopidogrel interruption before surgery.
- This study addresses the unknown safety profile of clopidogrel in the perioperative setting.
Purpose of the Study:
- To assess the perioperative bleeding risk in patients maintained on clopidogrel during general surgery.
- To compare bleeding complications between patients who discontinued clopidogrel and those who continued it.
- To evaluate the safety of continuing clopidogrel for elective general surgical procedures.
Main Methods:
- Prospective randomized study comparing clopidogrel continuation versus discontinuation.
- Patients undergoing elective general surgery were randomized into two groups.
- Primary endpoints included bleeding requiring transfusion, readmission, reoperation, or mortality within 90 days.
Main Results:
- No perioperative deaths, transfusions, or reoperations occurred in either group.
- One patient in each group was readmitted for intra-abdominal hematoma (4.8% vs 4.5%, P=1.0).
- No perioperative myocardial infarctions or cerebrovascular accidents were reported.
Conclusions:
- Continuing clopidogrel during commonly performed elective general surgery is safe.
- Patients can be maintained on clopidogrel without an increased risk of perioperative bleeding.
- Findings suggest a potential update to clinical guidelines regarding clopidogrel management.
Background:
The perioperative safety profile of clopidogrel, a potent antiplatelet agent used in the management of cardiovascular disease, is unknown, and there are no evidence-based guidelines recommending for either its interruption or continuation at this time. The aim of this study was to determine whether patients who are maintained on clopidogrel before general surgical procedures are at increased risk of perioperative bleeding complications.
Methods:
Patients receiving clopidogrel at the time of elective general surgery were randomized to either discontinue clopidogrel 1 week before surgery (group A) or continue clopidogrel into surgery (group B). All other antiplatelet and anticoagulant agents were discontinued before surgery. The primary end points were perioperative bleeding requiring intraoperative or postoperative transfusion of blood or blood components and bleeding-related readmission, reoperation, or mortality within 90 days of surgery. The secondary end points were perioperative myocardial infarction or cerebrovascular accidents within 90 days of surgery.
Results:
Thirty-nine patients were enrolled and underwent 43 general surgical operations. Twenty-one procedures were randomized to group A and 22 to group B. The most commonly performed individual procedures were open inguinal hernia repair (23%), laparoscopic cholecystectomy (21%), open ventral hernia repair (15%), laparoscopic ventral hernia repair (11%), and laparoscopic inguinal hernia repair (9%). No perioperative mortalities, bleeding events requiring blood transfusion, or reoperations occurred. One readmission for intra-abdominal hematoma requiring percutaneous drainage occurred in each group (group A: 4.8% vs group B: 4.5%; P = 1.0). No myocardial infarctions or cerebrovascular accidents were observed or reported.
Conclusions:
The outcomes from this prospective study suggest that, patients undergoing commonly performed elective general surgical procedures can be safely maintained on clopidogrel without increased perioperative bleeding risk.
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