Operative delay for orthopedic patients on clopidogrel (plavix): a complete lack of consensus.
BACKGROUND
: Because of its irreversible nature, Plavix (clopidogrel) has become a double edged sword in the care of some of our sickest patients, particularly when surgical intervention is required. Platelets exposed to a single dose of clopidogrel are affected for the remainder of their lifespan and recover normal platelet function at a rate consistent with platelet turnover, which is within 5 days to 7 days (1-3) with the generation of new platelets not influenced by the drug; however, delay of surgical fixation for orthopedic patients, particularly patients with hip fractures may lead to increased morbidity and mortality.


METHODS
: A Web-based survey was created and administered to the program directors of academic orthopedic surgery programs.


RESULTS
: Seventy-three percent of orthopedic residency programs responded that waiting 3 days or less for urgent but nonemergent operative interventions on patients on clopidogrel is acceptable with 23% feeling that no delay at all is necessary. For emergent surgery, the vast majority of programs 66 (89%) reported no delay to the operating room for patients on clopidogrel.


CONCLUSIONS
: 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.
Lavelle
William F
WF
Division of Orthopedic Surgery, Albany Medical College, Albany, New York, USA. lavellwf@yahoo.com
Demers Lavelle
Elizabeth A
EA
Uhl
Richard
R
D000328:Adult; D000077144:Clopidogrel; D004638:Emergency Treatment; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D019538:Health Care Surveys; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D020380:Needs Assessment; D009985:Orthopedics / Q000193:education; D019990:Perioperative Care / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011379:Prognosis; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine