Safety and Efficacy of Clopidogrel before Surgery

Clopidogrel is an antiplatelet drug that is used in patients who have had previous cerebrovascular events, acute coronary syndromes, or who underwent percutaneous coronary interventions (PCI) with bare metal or drug-eluting stents. About 5% of patients who undergo PCI have to undergo non-cardiac surgery within 1 year of coronary stent implantation. Patients who receive clopidogrel may be at increased risk of bleeding complications during surgery. The risk of coronary thrombosis after non-cardiac surgery increases, especially when surgery is performed early after stenting, and particularly when antiplatelet agents are withdrawn before surgery. The decision to continue or withhold clopidogrel should reflect a balance of the consequences of perioperative hemorrhage versus the risk of perioperative vascular complications. Close communication among surgeons, anesthesiologists, and cardiologist is necessary to minimize both adverse cardiac risk and surgical risk in those patients.