NEW YORK (Reuters Health) – Discontinuing clopidogrel before abdominal operation — whether elective or emergent — may not be necessary, a New York team advises. When discontinuation is deemed prudent, however, they recommend a 7-day preop washout period.

Writing in the Archives of Surgery for March, Dr. Celia M. Divino and colleagues at Mount Sinai School of Medicine, New York, point out that no clear consensus exists on optimal management of clopidogrel before abdominal operations. “Without definitive evidence-based guidelines, a general surgeon is required to balance the presumed bleeding risk with the risk of a thrombotic complication.”

To see if the timing of preoperative clopidogrel cessation affects outcomes, the team reviewed data on 104 patients receiving clopidogrel before undergoing abdominal operations. The last prior clopidogrel use was less than 7 days before surgery in 43 patients and at least 7 days in the other 61 subjects.

Rates of postoperative bleeding requiring blood transfusion were significantly greater in the group that continued on clopidogrel until closer to the operation (30%), compared with 13% among patients discontinuing clopidogrel at least a week beforehand (p=0.03), according to the report.

However, “No significant difference in postoperative hemorrhage resulting in reoperation or mortality was demonstrated between groups,” Dr. Divino and colleagues found.

Among patients undergoing elective procedures, postop bleeding requiring transfusion was not significantly more frequent in the patients on clopidogrel within 7 days of the operation (23%) compared with those ceasing use before then (14%; p=0.25)

Further analysis showed that most postop morbidity and mortality occurred in patients undergoing colorectal resection. In this subgroup, there was a trend toward more bleeding complications among those with more recent clopidogrel use (40%) than in patients with longer discontinuation (17%; p=0.053)

“We conclude that semi-emergency and emergency operative interventions should not be delayed based on recent clopidogrel use,” Dr. Divino and colleagues write. “In addition, cessation of clopidogrel before elective operative procedures in high-risk patients may not be necessary.”

However, they note, cessation is advisable before elective colorectal resection. “For physicians advising cessation of clopidogrel before elective abdominal surgical procedures, we recommend 7 days as a guideline.”

Arch Surg 2011;146:334-339.