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Operative Delay for Orthopedic Patients on Clopidogrel (Plavix): A Complete Lack of Consensus

2008; Lippincott Williams & Wilkins; Volume: 64; Issue: 4 Linguagem: Inglês

10.1097/ta.0b013e3180485d23

1529-8809

William F. Lavelle, Elizabeth A. Demers Lavelle, Richard L. Uhl,

Cardiac, Anesthesia and Surgical Outcomes

: Because of its irreversible nature, Plavix (clopidogrel) has become a double edged sword in the care of some of our sickest patients, particularly when surgical intervention is required. Platelets exposed to a single dose of clopidogrel are affected for the remainder of their lifespan and recover normal platelet function at a rate consistent with platelet turnover, which is within 5 days to 7 days (1-3) with the generation of new platelets not influenced by the drug; however, delay of surgical fixation for orthopedic patients, particularly patients with hip fractures may lead to increased morbidity and mortality.: A Web-based survey was created and administered to the program directors of academic orthopedic surgery programs.: Seventy-three percent of orthopedic residency programs responded that waiting 3 days or less for urgent but nonemergent operative interventions on patients on clopidogrel is acceptable with 23% feeling that no delay at all is necessary. For emergent surgery, the vast majority of programs 66 (89%) reported no delay to the operating room for patients on clopidogrel.: The majority of orthopedic surgery residency programs who responded to the survey wait less than 3 days for urgent surgery and do not delay surgery for emergency cases for patients on clopidogrel. At this point we feel that an early intervention that occurs within approximately 2 days, with the acceptance of the possibility of increased blood loss is in the patient's best interest. Based on the reviewed physiology, a perioperative platelet transfusion may be of some benefit as the transfused platelets would be effective in forming a viable plug.