Key result
Perioperative clopidogrel was associated with a higher rate of return trips to the operating room compared to no clopidogrel (6.5% vs 0.015%), which was not negated by stopping >7 days preoperatively.
Why the study?
Does discontinuing clopidogrel 7 days before surgery prevent major bleeding events requiring blood transfusions or return trips to the operating room in surgical patients?
Cohort (n=34,650)
No
Does discontinuing clopidogrel 7 days before surgery prevent major bleeding events requiring blood transfusions or return trips to the operating room in surgical patients?
Discontinuing clopidogrel 7 days before surgery may not be sufficient to prevent a significantly higher rate of reoperations for bleeding compared to patients not on clopidogrel.
Stopping clopidogrel >7 days preoperatively may not eliminate excess reoperation risk; leaves open optimal timing and requires prospective validation.
Despite the prevalence of surgical candidates on clopidogrel, no definitive guidelines exist for stopping the drug preoperatively. A 7 day off-clopidogrel period is commonly considered safe with regards to bleeding complications. We sought to put the 7-day window to the test with regards to major bleeding events requiring either blood transfusions or return trips to the operating room. We collected data for patients taking clopidogrel in the perioperative period between 2005 and 2007 (n = 170). This data was then compared with the data of all of the patients undergoing surgery at our institution for the same time period (n = 34,480). Patients taking clopidogrel experienced a significantly higher rate of return trips to the operating room (6.5%) compared with nonclopidogrel patients (0.015%). Interestingly, we found no significant difference between those stopping clopidogrel more than 7 days preoperatively and those that did not (5% and 7.5%, respectively). There did not seem to be a significant difference in blood transfusion rates between the two clopidogrel groups. Patients on perioperative clopidogrel require reoperations for bleeding at a significantly higher rate compared with patients not taking clopidogrel. Discontinuing clopidogrel 7 days before surgery is not enough to negate this difference and these patients still experience a drastically higher rate of reoperations for bleeding.
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Grujic et al. (2009) conducted a cohort in Surgical candidates (n=34,650). Perioperative clopidogrel vs. No clopidogrel was evaluated on Return trips to the operating room. Perioperative clopidogrel was associated with a higher rate of return trips to the operating room compared to no clopidogrel (6.5% vs 0.015%), which was not negated by stopping >7 days preoperatively.
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