Clopidogrel and surgery: "be aware"

Introduction: Clopidogrel has been used more recently to prevent thrombosis in occlusive arterial disease. It is known that clopidogrel increases bleeding during surgery. We performed a questionnaire survey of surgeons in Sri Lanka regarding their experience with clopidogrel.

Objectives: To share the experience of surgeons from diverse fields regarding surgery on patients on clopidogrel.

Method: A retrospective descriptive study was performed using a questionnaire.

Results: 48 completed questionnaires were received. 21 (44%) Surgeons reported complications relating to clopidogrel. Spontaneous haemorrhage was reported by 8, which manifested as ecchymotic patches in the majority. Most surgeons 36 (75%) preferred aspirin over clopidogrel and 10 (21%) opted for clopidogrel. The majority recommend stopping of clopidogrel at least for 14 days. However, the opinions of the rest varied from 7 to 28 days.

Conclusions: Surgeons felt clopidogrel has the potential to cause complications following surgery. Majority were of the opinion that it is safe practice to stop clopidogrel for at least 14 days which is more than the 5 days recommended by the formularies. A significant majority were comfortable to have the patient on aspirin compared with clopidogrel.

DOI: 10.4038/sljs.v28i1.3047

The Sri Lanka Journal of Surgery 2010: 28: 1-4