Cessation of Clopidogrel Before Major Abdominal Procedures

OBJECTIVE: To determine whether timing of clopidogrel bisulfate cessation influences outcome after abdominal operations. METHODS: A review was performed of 104 patients receiving clopidogrel who underwent abdominal operations between March 2003 and March 2009. Patients were grouped by last clopidogrel use: group A (<7 days) and group B (≥7 days). RESULTS: Of 104 patients, 43 were in group A and 61 were in group B. Overall, 6 deaths occurred (group A, 5 patients 12% vs group B, 1 2%; P = .03) and 27 patients required intensive care unit admission (group A, 16 patients 37% vs group B, 11 18%; P = .03). Twenty-one patients developed a postoperative bleeding complication; 19 complications were managed by blood transfusion and 2 required reoperation. Group A vs group B had significantly increased rates of postoperative bleeding requiring blood transfusion (13 patients 30% vs 8 13%; P = .03). No significant difference in postoperative bleeding resulting in reoperation or mortality was demonstrated. Timing of clopidogrel cessation within 7 days did not affect postoperative bleeding risk. Eighty-nine patients (86%) underwent elective operations (group A, 30 patients 70% vs group B, 59 97%; P < .001). While elective patients in group A vs those in group B demonstrated a trend toward increased risk of postoperative bleeding requiring transfusion (7 patients 23% vs 8 14%; P = .25), no significant difference in intensive care unit admission (group A, 6 patients 20% vs group B, 9 15%; P = .31) or mortality (1 3% vs 1 2%; P = .62) was demonstrated. CONCLUSIONS: While clopidogrel use within 7 days of an operation significantly increased the risk of postoperative bleeding, most bleeding episodes were successfully managed by transfusion without an increase in bleeding-related mortality or necessity for reoperation. After controlling for operative urgency, no significant difference in mortality or intensive care unit admission was demonstrated in patients undergoing elective procedures. High-risk patients undergoing elective operations may not require preoperative clopidogrel cessation. When clopidogrel cessation is warranted, 7 days before the procedure is recommended. Perioperative risk does not vary by timing of cessation within 7 days of an operation.