Related Experiment Video
Updated: Mar 17, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Preoperative antiplatelet use does not increase incidence of bleeding after major operations
David S Strosberg1, Todd Corbey2, Jon C Henry3
1Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Insights
Continuing clopidogrel before surgery appears safe for patients undergoing major operations. This study found no increased risk of adverse events like bleeding or death when patients took clopidogrel perioperatively.
Area of Science:
- Cardiology
- Surgical Oncology
- Pharmacology
Background:
- Clopidogrel is an antiplatelet medication commonly used in patients with coronary artery disease.
- Decisions regarding preoperative clopidogrel management can impact patient safety and surgical outcomes.
- Understanding the risks associated with continuing or holding clopidogrel is crucial for perioperative care.
Purpose of the Study:
- To evaluate the safety and outcomes of patients who continued or held clopidogrel therapy before major surgical procedures.
- To determine if preoperative clopidogrel use is associated with increased adverse events.
Main Methods:
- A retrospective review of 205 major general thoracic and vascular operations performed between 2009-2012.
- Patients taking clopidogrel were divided into two groups: those holding the drug for ≥5 days before surgery and those taking it within 5 days.
- Data collected included demographics, comorbidities, aspirin use, stent details, and perioperative events.
Main Results:
- No significant differences were observed between the groups regarding estimated blood loss, transfusion requirements, myocardial infarction, stroke, or 30-day mortality.
- 11.5% of patients were taking clopidogrel preoperatively, with 56.6% holding the drug and 43.4% continuing it within 5 days of surgery.
- Adverse outcomes such as bleeding, ischemia, or death were comparable in both groups.
Conclusions:
- Continuing clopidogrel therapy in the preoperative period does not appear to significantly increase adverse patient outcomes.
- It is considered reasonable and safe to continue clopidogrel in elective surgical situations.
- Preoperative clopidogrel use did not elevate bleeding risk in emergency circumstances.
Background:
This study examined the outcomes of patients holding or continuing clopidogrel during the preoperative period.
Methods:
We reviewed all patients taking clopidogrel who underwent one of 72 different Current Procedural Terminology code procedures, representing major emergency and elective general thoracic and vascular operations from 2009-2012 at a single institution. Demographics, comorbidities, aspirin use, details of coronary stents, and perioperative events were collected.
Results:
A total of 2,154 major operative procedures were performed on 1,851 patients during the study period. A total of 213 patients (11.5%) were taking clopidogrel at the time of their last office visit or hospital admission and were then instructed to hold or continue the drug prior to an operation. A total of 205 procedures in 200 patients comprised the final study population. Clopidogrel was held in 116 procedures for ≥5 days prior to operative intervention (56.6%, Group A), and clopidogrel was administered within 5 days of an operation in 89 procedures (43.4%, Group B). There were no differences between the 2 groups regarding estimated blood loss, units transfused, myocardial infarction, stroke, acute visceral or peripheral ischemia, or death within 30 days.
Conclusion:
We did not identify significantly increased adverse patient outcomes in those patients who received preoperative clopidogrel within this population. We assert that it appears to be reasonable and safe to continue antiplatelet therapy with clopidogrel in this population in elective situations and that preoperative clopidogrel use does not increase the risk of bleeding in emergency circumstances.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:22Aneurysm IV: Nursing Management
01:22Formation of the Platelet Plug
As the injured blood vessel contracts, endothelial cells undergo contraction, revealing collagen fibers in the basement membrane and underlying connective tissue. Furthermore, the plasma membrane of endothelial cells becomes adhesive, preparing the site for platelet adhesion. Platelets...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:30Venous Thrombosis IV: Nursing Management