title: The evaluation of clopidogrel use in perioperative general surgery patients: a prospective randomized controlled trial.
abstract: BACKGROUND
  The perioperative safety profile of clopidogrel, a potent antiplatelet agent used in the management of cardiovascular disease, is unknown, and there are no evidence-based guidelines recommending for either its interruption or continuation at this time. The aim of this study was to determine whether patients who are maintained on clopidogrel before general surgical procedures are at increased risk of perioperative bleeding complications.
  
  
  METHODS
  Patients receiving clopidogrel at the time of elective general surgery were randomized to either discontinue clopidogrel 1 week before surgery (group A) or continue clopidogrel into surgery (group B). All other antiplatelet and anticoagulant agents were discontinued before surgery. The primary end points were perioperative bleeding requiring intraoperative or postoperative transfusion of blood or blood components and bleeding-related readmission, reoperation, or mortality within 90 days of surgery. The secondary end points were perioperative myocardial infarction or cerebrovascular accidents within 90 days of surgery.
  
  
  RESULTS
  Thirty-nine patients were enrolled and underwent 43 general surgical operations. Twenty-one procedures were randomized to group A and 22 to group B. The most commonly performed individual procedures were open inguinal hernia repair (23%), laparoscopic cholecystectomy (21%), open ventral hernia repair (15%), laparoscopic ventral hernia repair (11%), and laparoscopic inguinal hernia repair (9%). No perioperative mortalities, bleeding events requiring blood transfusion, or reoperations occurred. One readmission for intra-abdominal hematoma requiring percutaneous drainage occurred in each group (group A: 4.8% vs group B: 4.5%; P = 1.0). No myocardial infarctions or cerebrovascular accidents were observed or reported.
  
  
  CONCLUSIONS
  The outcomes from this prospective study suggest that, patients undergoing commonly performed elective general surgical procedures can be safely maintained on clopidogrel without increased perioperative bleeding risk.
authors.affiliation: Division of Genery Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1259, New York, NY 10029, USA.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Chu
authors.affiliation: Division of Genery Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1259, New York, NY 10029, USA.
authors.forename: Artur
authors.initials: A
authors.lastname: Chernoguz
authors.affiliation: Division of Genery Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1259, New York, NY 10029, USA. Electronic address: celia.divino@mountsinai.org.
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D000077144:Clopidogrel; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D013502:General Surgery; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; 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*; D016896:Treatment Outcome
chemical_list: D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Abdominal surgery; Bleeding risk; Clopidogrel; General surgery; Noncardiac surgery; Plavix