title: Perioperative management of patients on clopidogrel (Plavix) undergoing major lung resection.
abstract: BACKGROUND
  Management of patients requiring antiplatelet therapy with clopidogrel (Plavix) and major lung resection must balance the risks of bleeding and cardiovascular events. We reviewed our experience with patients treated with clopidogrel perioperatively to examine outcomes, including results of a new strategy for high-risk patients.
  
  
  METHODS
  Patients who underwent major lung resection and received perioperative clopidogrel between January 2005 and September 2010 were reviewed. Initially, clopidogrel management consisted of discontinuation approximately 5 days before surgery and resumption immediately after surgery. After July 2010, high-risk patients (drug-eluting coronary stent placement within prior year or previous coronary event after clopidogrel discontinuation) were admitted 2 to 3 days preoperatively and bridged with the intravenous glycoprotein IIb/IIIa receptor inhibitor eptifibatide (Integrilin) according to a multidisciplinary cardiology/anesthesiology/thoracic surgery protocol. Outcomes were compared with control patients (matched for preoperative risk factors and extent of pulmonary resection) who did not receive perioperative clopidogrel.
  
  
  RESULTS
  Fifty-four patients who had major lung resection between January 2005 and September 2010 and received clopidogrel perioperatively were matched with 108 control subjects. Both groups had similar mortality, postoperative length of stay, and no differences in the rates of perioperative transfusions, reoperations for bleeding, myocardial infarctions, and strokes. Seven of the 54 clopidogrel patients were admitted preoperatively for an eptifibatide bridge. Two of these patients received perioperative transfusions, but there were no deaths, reoperations, myocardial infarctions, or stroke.
  
  
  CONCLUSIONS
  Patients taking clopidogrel can safely undergo major lung resection. Treatment with an eptifibatide bridge may minimize the risk of cardiovascular events in higher risk patients.
authors: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors: Duykhanh P
authors: DP
authors: Ceppa
authors: Ian J
authors: IJ
authors: Welsby
authors: Tracy Y
authors: TY
authors: Wang
authors: Mark W
authors: MW
authors: Onaitis
authors: Betty C
authors: BC
authors: Tong
authors: David H
authors: DH
authors: Harpole
authors: Thomas A
authors: TA
authors: D'Amico
authors: Mark F
authors: MF
authors: Berry
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D000077542:Eptifibatide; D006801:Humans; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011013:Pneumonectomy; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000077542:Eptifibatide; D013988:Ticlopidine