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Is it Safe to Continue Clopidogrel in Elective Hip and Knee Arthroplasty?
David G Maxfield1, Thomas L Bernasek2, Corey C Engel3
1Florida Orthopaedic Institute, Adult Reconstruction, Tampa, FL.
Insights
Continuing clopidogrel in patients undergoing elective hip and knee arthroplasty is safe, with no increased risk of complications. This finding supports further research into perioperative clopidogrel management for these procedures.
Area of Science:
- Orthopedic Surgery
- Cardiology
- Pharmacology
Background:
- No current evidence-based guidelines exist for perioperative clopidogrel use in elective hip and knee arthroplasty.
- This study addresses the gap by comparing outcomes in patients who continued clopidogrel versus those who had it withheld.
Purpose of the Study:
- To evaluate the safety and outcomes of continuing clopidogrel therapy during elective total hip and knee arthroplasty.
- To compare transfusion rates, complications, and readmissions between patients on and off clopidogrel.
Main Methods:
- Retrospective analysis of 158 patients undergoing elective hip or knee arthroplasty while taking clopidogrel.
- Patients were divided into two groups: clopidogrel continued or held before surgery.
- Primary endpoints included transfusion and 90-day readmission; secondary endpoints covered complications like bleeding, infection, re-operation, and major adverse events.
Main Results:
- No significant differences in wound drainage, infection, readmission, major complications, length of stay, or mortality between groups.
- Patients continuing clopidogrel had a higher likelihood of receiving a blood transfusion (9.1% vs. 0%).
- No difference in blood loss was observed with cementless implants, and general anesthesia was more common in the clopidogrel group.
Conclusions:
- Elective hip and knee arthroplasty patients can safely continue clopidogrel without increased risk of wound complications, infections, or major adverse events.
- The findings suggest that clopidogrel cessation may not be necessary for these procedures.
- Further prospective research is recommended to confirm these safety findings.
Background:
No evidence-based guidelines exist for the perioperative use of clopidogrel in elective hip and knee arthroplasty patients. This study compares the preoperative, intraoperative, and postoperative outcomes of total hip and knee arthroplasty in patients maintained on clopidogrel and with patients whose clopidogrel was held before surgery.
Methods:
We retrospectively identified 158 patients taking clopidogrel before undergoing elective total hip or knee arthroplasty. Patients were stratified for having clopidogrel held or continued, based on the interval between latest dose and date of surgery. The primary end points were receipt of transfusion and readmission within 90 days of surgery. Secondary end points were the incidence of complications such as bleeding, infection, re-operation, and major cardiac or neurologic events such as myocardial infarction or stroke during the 90-day postoperative period.
Results:
The two cohorts had similar demographics. Patients who continued clopidogrel were more likely to receive a blood transfusion postoperatively (9.1% vs 0%, P = .005), but there was no difference in wound drainage (P = .65), wound infection (P = .24), readmission (P = .74), major complications (P = .64), length of stay (P = .70), or mortality (P = .42). Patients who continued clopidogrel before surgery were more likely to have received general anesthesia (P < .001) per anesthesia protocol, however, three such patients did receive spinal anesthesia without any complications. With cementless implants, blood loss was not different between clopidogrel groups.
Conclusion:
Patients undergoing elective total hip and knee arthroplasty may be safely maintained on clopidogrel without an increased risk of wound complications, infections, length of stay, readmission, reoperation, major medical complications, or mortality. Further prospective research is warranted to confirm the effects of continuing clopidogrel in patients undergoing elective hip and knee arthroplasty.
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