title: Continuing clopidogrel during elective total hip and knee arthroplasty: assessment of bleeding risk and adverse outcomes.
abstract: Limited research assessing risks of continued clopidogrel perioperatively in patients undergoing elective orthopedic procedures exists. Patients that underwent elective primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) from 2007 to 2012 while taking clopidogrel at the time of surgical evaluation were retrospectively identified. Patient demographics, last dose of clopidogrel, intraoperative blood loss, blood transfusion, and presence of 30-day adverse cardiac events (ACE) were collected. Of 142 patients meeting criteria, 24 (16.9%) patients remained on clopidogrel perioperatively. Patients that continued clopidogrel were more likely to receive a blood transfusion within 24 hours of surgery (31.8% vs. 7.7%; P=0.004) and during hospitalization (37.5% vs. 15.3%; P=0.02), but the incidence of 30-day ACE was not significantly different. Continuation of clopidogrel perioperatively for elective THA or TKA should be carefully considered.
authors.affiliation: Departments of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Adam K
authors.initials: AK
authors.lastname: Jacob
authors.affiliation: Departments of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Hurley
authors.affiliation: Departments of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Loughran
authors.affiliation: Departments of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Wetsch
authors.affiliation: Departments of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Trousdale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001803:Blood Transfusion; D000077144:Clopidogrel; D017558:Elective Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: bleeding risk; clopidogrel; total hip and knee arthroplasty