title: Ticlopidine and clopidogrel, sometimes combined with aspirin, only minimally increase the surgical risk in renal transplantation: a case-control study.
abstract: BACKGROUND
  Patients undergoing kidney transplantation are sometimes being treated with antiplatelet agents such as ticlopidine or clopidogrel. Some teams refuse to wait-list these patients for fear of bleeding during transplant surgery.
  
  
  METHODS
  We retrospectively reviewed the records of 702 adult patients with a kidney transplant alone between 2000 and 2010. Nineteen (2.7%) patients were taking clopidogrel or ticlopidine when called in for transplantation. Furthermore, 10 of these 19 patients were also taking low-dose aspirin (ASA). We compared the risk of bleeding peri- and postoperatively, and the occurrence of cardiovascular complications within 30 days after renal transplantation between 19 cases and 39 controls randomly selected within the cohort.
  
  
  RESULTS
  Platelets were administered to 7 cases (37%) versus 0 controls (P<0.001). A single case (5.3%) presented with significant bleeding during surgery following an implantation biopsy, and required 4 red bood cell (RBC) units. During the first day, 3 of the 19 cases (16%) and 1 of the 39 controls required RBC (P=0.1). No reoperation was performed for bleeding. After the transplant, clopidogrel or ticlopidine was resumed in only two patients. The platelet count and haemoglobin were similar between cases and controls at Day 30. No cardiovascular event occurred in cases or controls during the first month post-transplantation. At 5 years, graft and patient survival was similar in cases and controls.
  
  
  CONCLUSIONS
  Clopidogrel and ticlopidine, sometimes in combination with ASA, are associated with a low risk of bleeding during renal transplantation and does not seem to be a contraindication for renal transplant surgery.
authors.affiliation: Department of Nephrology and Dialysis, CHU Charleroi, Charleroi, Belgium.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Benahmed
authors.forename: Mireille
authors.initials: M
authors.lastname: Kianda
authors.forename: Lidia
authors.initials: L
authors.lastname: Ghisdal
authors.forename: Nilufer
authors.initials: N
authors.lastname: Broeders
authors.forename: Annick
authors.initials: A
authors.lastname: Massart
authors.forename: Anne
authors.initials: A
authors.lastname: Lemy
authors.forename: Dimitri
authors.initials: D
authors.lastname: Mikhalski
authors.forename: Anh Dung
authors.initials: AD
authors.lastname: Hoang
authors.forename: Vincent
authors.initials: V
authors.lastname: Donckier
authors.forename: Claude
authors.initials: C
authors.lastname: Sadis
authors.forename: Alain
authors.initials: A
authors.lastname: Le Moine
authors.forename: Philippe
authors.initials: P
authors.lastname: Madhoun
authors.forename: Judith
authors.initials: J
authors.lastname: Racapé
authors.forename: Martin
authors.initials: M
authors.lastname: Wissing
authors.forename: Daniel
authors.initials: D
authors.lastname: Abramowicz
mesh_terms: D001241:Aspirin / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D016022:Case-Control Studies; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013988:Ticlopidine / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: bleeding; platelet aggregation inhibitors; renal transplantation; surgical complications; thrombotic complications