Safety of carotid endarterectomy while on clopidogrel (Plavix). Clinical article.
OBJECTIVE
Many patients undergoing carotid endarterectomy (CEA) regularly take clopidogrel, a permanent platelet inhibitor. The authors sought to determine whether taking clopidogrel in the period before CEA leads to more bleeding or other complications.


METHODS
The authors performed a retrospective, institutional review board–approved review of 182 consecutive patients who underwent CEA. Clinical, radiographic, and surgical data were gleaned from hospital and clinic records. Analysis was based on the presence or absence of clopidogrel in patients undergoing CEA and was performed twice by considering clopidogrel use within 8 days and within 5 days of surgery to define the groups.


RESULTS
Taking clopidogrel within 8 days before surgery resulted in no statistical increase in any measure of morbidity or death. Taking clopidogrel within 5 days was associated with a small but significant increase in operative blood loss and conservatively managed postoperative neck swelling. No measure of permanent morbidity or death was increased in either clopidogrel group.


CONCLUSIONS
Findings in this study support the safety of preoperative clopidogrel in patients undergoing CEA.
Wait
Scott D
SD
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Abla
Adib A
AA
Killory
Brendan D
BD
Starke
Robert M
RM
Spetzler
Robert F
RF
Nakaji
Peter
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D000077144:Clopidogrel; D015331:Cohort Studies; D004487:Edema / Q000139:chemically induced / Q000453:epidemiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology*; D011517:Prothrombin Time; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000453:epidemiology; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin