Clopidogrel and Bleeding after General Surgery Procedures

Abstract

Although many studies in the cardiothoracic literature exist about the relationship between clopidogrel and postoperative bleeding, there is scarce data in the general surgery literature. We assessed whether there are increased bleeding complications, morbidity, mortality, and resource utilization in patients who are on clopidogrel (Plavix®) within 1 week before undergoing a general surgery procedure. Fifty consecutive patient charts were retrospectively reviewed after identifying patients who had pharmacy orders for clopidogrel and who underwent a general surgery procedure between 2003 and 2007. Patients who took clopidogrel within 6 days before surgery (group I, n = 28) were compared with patients who stopped clopidogrel for 7 days or more (group II, n = 22). A larger percentage of patients who took their last dose of clopidogrel within 1 week of surgery (21.4% vs 9.5%) had significant bleeding after surgery requiring blood transfusion. However, there were no significant differences between the groups in operative or postoperative blood transfusions ( P = 0.12, 0.53), decreases in hematocrit ( P = 0.21), hospital stay ( P = 0.09), intensive care unit stay ( P = 0.41), late complications ( P = 0.45), or mortality ( P = 0.42). Although our cohort is limited in size, these results suggest that in the case of a nonelective general surgery procedure where outcomes depend on timely surgery, clopidogrel taken within 6 days before surgery should not be a reason to delay surgery. However, careful attention must be paid to meticulous hemostasis, and platelets must be readily available for transfusion in the operating room.

Perioperative Platelet Inhibition in Elective Inguinal Hernia Surgery—Increased Rate of Postoperative Bleeding and Hematomas?

“…Only 5% of patients under clopidogrel developed a postoperative hematoma. 24 In line with the majority of studies, we were unable to detect an increased risk of bleeding complications under mono antiplatelet therapy. The majority of complications could be treated conservatively.…”

Experience using pipeline embolization device with Shield Technology in a patient lacking a full postoperative dual antiplatelet therapy regimen

“…A dual antiplatelet regimen must be balanced in accordance with the risks of thromboembolic and hemorrhagic complications. 8 However, while it is difficult to properly extrapolate, cardiointerventional practice still suggests that regimen adjustment does not make a significant impact on the outcome. 9 The possibility 10 of delayed hemorrhages from procedural complications, silent or treated IA ruptures, or postoperative interventions means that discovery of ways to reduce dependence of FDD patients on DAT in the postoperative period could reduce long-term complication rates.…”

Factors Associated with Inadequate Management of Antiplatelet Agents in Perioperative Period of Non-Cardiac Surgeries

“…This conduct can potentially expose patients to cardiac complications in the perioperative period once the literature evidences that those medicines, after being suspended for 8-10 days, lose their antiplatelet agent’s effect. 25 , 26 Cases where the conduct of suspending the drug was correct were also observed, but for a period shorter than that recommended in the guidelines and, so, the goal of losing the pharmacological effect of the antiplatelet agent is never reached once that effect at platelet level is irreversible, and the time they remain active is approximately 10 days. 26 …”

“…As to patients who already had an AMI episode and are in the group where the antiplatelet therapy complies more with the guidelines in the perioperative period, one can understand that surgeons and doctors in charge of this medicine management look for avoiding reinfarction, and so they instruct their patients not to suspend aspirin or clopidogrel in the preoperative period of non-cardiac surgeries, thus abiding by the recommendations in the guidelines and advocated by other authors. 15 , 24 , 25 , 27 , 38 …”