Plavix, clopidogrel use within 7 days of an operation significantly increased the risk of postoperative bleeding!
Plavix, clopidogrel cessation 7 days before operation is recommended
Arch Surg. 2011 Mar;146(3):334-9.
Cessation of clopidogrel before major abdominal procedures.
Department of Surgery, Mount Sinai School of Medicine, 5 E 98th St, 15th Floor, Box 1259, New York, NY 10029. firstname.lastname@example.org.
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.