title: Management and outcomes of patients on preoperative plavix (clopidogrel) undergoing general thoracic surgery.
abstract: OBJECTIVE
  Plavix (clopidogrel) is a potent antiplatelet agent used to prevent thrombosis in a variety of clinical settings. The perioperative management of thoracic surgery patients who are on clopidogrel at the time of surgery is not well defined. We conducted this review to examine the perioperative management and outcomes of patients undergoing general thoracic surgical procedures.
  
  
  METHODS
  From January 2005 to January 2010, 165 patients on clopidogrel underwent 182 operative procedures. Three management strategies were identified: Group I: clopidogrel continued through surgery (n = 17), Group II: clopidogrel discontinued with a bridging agent (n = 44) and Group III clopidogrel discontinued without a bridging agent (n = 121). Propensity score matched cohorts (17 clopidogrel continued; 34 clopidogrel discontinued) were constructed based on age, clopidogrel indication, American Society of Anesthesiology status, and procedure and used to compare the impact of clopidogrel management on postoperative bleeding and cardiovascular morbidity.
  
  
  RESULTS
  Unmatched analysis revealed a significantly higher rate of transfusion in the group of patients who continued on clopidogrel throughout the perioperative period, compared with patients who had clopidogrel discontinued. Although there were more cardiovascular events in Groups II and III, there were no significant differences between groups in postoperative mortality, myocardial infarction, stroke, or reoperation for bleeding. In propensity matched patients only the rate of postoperative transfusions was significantly higher in patients continued on clopidogrel compared with patients whose clopidogrel was discontinued (35.3 vs. 2.9%), p < 0.004.
  
  
  CONCLUSIONS
  In selected patients, some thoracic surgical procedures can be performed safely on clopidogrel but are associated with higher rates of postoperative transfusion.
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.forename: Cameron
authors.initials: C
authors.lastname: Stock
authors.forename: Ya-lin
authors.initials: YL
authors.lastname: Chiu
authors.forename: Amanda
authors.initials: A
authors.lastname: Kansler
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Port
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lee
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.forename: Abu
authors.initials: A
authors.lastname: Nasar
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002318:Cardiovascular Diseases / Q000209:etiology / Q000628:therapy; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D057216:Propensity Score; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine