Perioperative clopidogrel (Plavix) continuation in shoulder arthroplasty: approach cautiously

Background While the effect of clopidogrel on outcomes in elective hip and knee arthroplasty has been well described, there is a paucity of data regarding elective shoulder arthroplasty. Methods Fifty-eight patients were identified who underwent primary anatomic total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty while prescribed clopidogrel. There were 33 (57%) reverse shoulder arthroplasties and 25 (43%) TSAs performed. Patients were separated into two groups based upon their use of clopidogrel in the preoperative period. Twenty patients (35%; group 1) continued clopidogrel through surgery, and 38 patients (65%; group 2) did not. The mean age was 74 years, and the mean follow-up was 42 months. Results Both groups demonstrated substantial improvements in pain and motion: visual analog scale pain improved by 7 points ( P < .001), elevation by 71° ( P < .001), external rotation by 29° ( P < .001), and internal rotation by 1.7 points ( P < .001), with no significant difference between groups. At the final follow-up, the mean American Shoulder and Elbow Surgeons score was 77 in group 1 and 86 in group 2 ( P = .067, minimum clinically important difference = 9). Estimated blood loss was 176 mL in group 1 and 127 in group 2 ( P = .02). There was one transfusion in group 1 (5%) and 0 in group 2 ( P = .16). The 90-day complication rates were 3/20 (15%) in group 1 and 0/37 in group 2 (hazard ratio = 13, P = .14). There was no statistically significant difference between groups for 30-day adverse cardiac events (2.6% and 0%, respectively, P = .46). Conclusion For the patients who continued clopidogrel preoperatively, estimated blood loss was significantly higher and trended toward a lower American Shoulder and Elbow Surgeons score (with differences meeting the minimum clinically important difference) and a higher 90-day complication rate. Perioperative continuation of clopidogrel in shoulder arthroplasty should be approached cautiously.