Operative Delay for Orthopedic Patients on Clopidogrel (Plavix): A Complete Lack of Consensus

Abstract

: The majority of orthopedic surgery residency programs who responded to the survey wait less than 3 days for urgent surgery and do not delay surgery for emergency cases for patients on clopidogrel. At this point we feel that an early intervention that occurs within approximately 2 days, with the acceptance of the possibility of increased blood loss is in the patient's best interest. Based on the reviewed physiology, a perioperative platelet transfusion may be of some benefit as the transfused platelets would be effective in forming a viable plug.

Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression

“…1). Nine additional papers were identified after searching of study references and articles that had cited identified studies [24,[30][31][32][33][34][35][36][37]. Thirty-one studies deemed to be relevant to the research question underwent full text review.…”

“…Cross sectional studies have identified wide variations in current clinical practice with regards to clopidogrel withdrawal before hip fracture surgery [22,23,24]. Most reports regarding clopidogrel are small, single centre studies, which do not allow meaningful conclusions to be drawn.…”

How to optimize patients for geriatric fracture surgery

“…Although to our knowledge there is no consensus or level 1 or 2 evidence for the treatment of patients on clopidogrel [70][71][72], the basic debate is whether the increased risk of bleeding caused by immediate surgery is worth the risk of increased morbidity and mortality from a delay of 7 to 9 days. The current protocol for patients taking clopidogrel at our two institutions is immediate surgery.…”

Effects of Anticoagulants on Outcome of Femoral Neck Fracture Surgery

“…12,13 There is no consensus on preoperative anticoagulation management in patients undergoing surgery for femoral neck fracture. 14,15 In our unit dedicated for hip fractures, the protocols for patients on anticoagulants undergoing surgery for femoral neck fracture are to continue aspirin and clopidogrel but to cease warfarin. 16 For patients on warfarin, if thrombophilia or a mechanical valve is indicated, heparin is infused once the international normalised ratio (INR) is <2 and the patient is considered ready for surgery once the INR is <1.5.…”