Perioperative Clopidogrel and Postoperative Events after Hip and Knee Arthroplasties
| Autor: | Mehran Aghazadeh, James V. Bono, Carl T. Talmo, Claire E. Robbins, Sumon Nandi |
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| Rok vydání: | 2012 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Ticlopidine Databases Factual Arthroplasty Replacement Hip medicine.medical_treatment Postoperative Hemorrhage Drug Administration Schedule Clinical Research Risk Factors Humans Medicine Orthopedics and Sports Medicine cardiovascular diseases Arthroplasty Replacement Knee Perioperative Period Unicompartmental knee arthroplasty Aged Retrospective Studies business.industry Vascular disease Age Factors General Medicine Perioperative medicine.disease Clopidogrel Surgery Discontinuation Survival Rate Regimen Anesthesia Platelet aggregation inhibitor Female business Platelet Aggregation Inhibitors circulatory and respiratory physiology medicine.drug |
| Zdroj: | Clinical Orthopaedics & Related Research. 470:1436-1441 |
| ISSN: | 0009-921X |
| DOI: | 10.1007/s11999-012-2306-7 |
| Popis: | Hip and knee arthroplasties are widely performed and vascular disease among patients having these procedures is common. Clopidogrel is a platelet inhibitor that decreases the likelihood of thrombosis. It may cause intraoperative and postoperative bleeding, but its discontinuation increases the risk of vascular events. There is currently no consensus regarding the best perioperative clopidogrel regimen that balances these concerns.We determined (1) the relationship between time of perioperative clopidogrel administration and postoperative bleeding-related events after hip and knee arthroplasties and (2) patient characteristics or surgical factors that may predict these events.We retrospectively queried our inpatient pharmacy database for patients who received clopidogrel from 2007 to 2009 and identified 116 patients who underwent hip or knee arthroplasty. We recorded the time of perioperative clopidogrel administration, bleeding-related postoperative events, patient characteristics, and surgical factors.Patients who withheld clopidogrel 5 or more days before hip or knee arthroplasty had lower rates of reoperation for infection and antibiotics prescribed for the surgical wound. Postoperative events did not vary with timing of clopidogrel resumption after surgery. Advanced age, an American Society of Anesthesiologists (ASA) score of 4, and revision surgery predicted increased readmission, reoperation for hematoma or infection, antibiotic use, and death.Holding clopidogrel for at least 5 days before hip or knee arthroplasty may lower the rate of bleeding-related events. We found no increase in events when patients resumed clopidogrel immediately after surgery. Advanced age, ASA score of 4, and revision surgery may be risk factors for bleeding-related events.Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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