title: Cessation of clopidogrel before major abdominal procedures.
abstract: 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.
authors.affiliation: Department of Surgery, Mount Sinai School of Medicine, 5 E. 98th St., New York, NY 10029, USA.
authors.forename: Artur
authors.initials: A
authors.lastname: Chernoguz
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.forename: Edward
authors.initials: E
authors.lastname: Chu
authors.forename: Junko
authors.initials: J
authors.lastname: Ozao-Choy
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Tammaro
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D000704:Analysis of Variance; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control; D000077144:Clopidogrel; D015331:Cohort Studies; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000401:mortality / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods; D015996:Survival Rate; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine