title: The use of clopidogrel (Plavix) in patients undergoing nonelective orthopaedic surgery.
abstract: OBJECTIVE
  To assess the effects of Plavix on patients requiring nonelective orthopaedic surgery.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University-affiliated teaching institutions.
  
  
  METHODS
  The orthopaedic trauma registry was used to retrospectively identify all patients taking clopidogrel (Plavix; Bristol-Myers Squibb/Sanofi Pharmaceuticals, Bridgewater, NJ) who required nonelective orthopaedic surgery from 2004 to 2008. Twenty-nine patients were identified on Plavix (PG) and 32 matched patients in the control group not taking Plavix (NPG). The Plavix group was separated into those with a surgical delay less than 5 days of the last dose (PG < 5) (n = 28) and a delay greater than 5 days (PG > 5) (n = 1). A randomized age- and injury-matched control group not on Plavix was separated with surgical delay less than 5 days (NPG < 5) (n = 29) and delay greater than 5 days (NPG > 5) (n = 3).
  
  
  METHODS
  A retrospective review was performed comparing pre- and postoperative hemoglobin, blood transfusion requirements, surgical delay, 30-day mortality, and postoperative complications.
  
  
  METHODS
  Statistical analyses were performed using the Student t test and chi square test to identify differences between the groups.
  
  
  RESULTS
  : The mean preoperative hemoglobin of the PG and the NPG was 11.2 g/dL and 12.3 g/dL (P = 0.03). Transfusion rates were similar with 18 of 28 in the PG compared with 13 of 29 in the NPG (P = 0.22). The mean surgical delay between the PG and NPG was 1.88 and 1.68 days (P = 0.64). Overall complications between the PG and NPG was nine of 28 and nine of 29 (P = 0.92). In both groups, two patients had postoperative wound drainage, which resolved without intervention. One patient in each group required revision surgery for nonunion. The 30-day mortality in the Plavix group was zero of 28 (0%) compared with one of 29 (3%) in the control group (cardiac arrest) (P = 0.32).
  
  
  CONCLUSIONS
  In this study, there were no serious complications or increased transfusion requirements in the Plavix group. Avoiding surgical delay for patients on Plavix requiring nonelective orthopaedic surgery appears to be safe. The goal should be early operative intervention to decrease the morbidity and mortality of surgical delay. This is especially true for patients with hip fractures, which was the most common nonelective orthopaedic surgery required of patients on Plavix in this study.
authors.affiliation: Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131, USA. OrthoDrJN@gmail.com
authors.forename: Jason A
authors.initials: JA
authors.lastname: Nydick
authors.forename: Eric D
authors.initials: ED
authors.lastname: Farrell
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Marcantonio
authors.forename: Eric L
authors.initials: EL
authors.lastname: Hume
authors.forename: Robert
authors.initials: R
authors.lastname: Marburger
authors.forename: Robert F
authors.initials: RF
authors.lastname: Ostrum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D000077144:Clopidogrel; D015331:Cohort Studies; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine