2006 Papers - Wong


Periprocedure bleeding of patients on clopidogrel.

David K.M. Wong, MD, University of Hawaii Surgical Residency Program
Faculty Supervision: Linda L. Wong, MD, FACS

Background: Since the mid-1990s, clopidogrel has revolutionized treatment of coronary, cerebrovascular and peripheral vascular syndromes and is the 7th leading drug in terms sales. Bleeding is a known complication but we wanted to characterize those patients that had bleeding complications.

Methods: We reviewed 180 patients with pharmacy charges for clopidogrel, operating-room charges and bleeding complications as defined by at least one of 7 ICD-9 diagnosis codes during 1/1/03 -1/10/05.

Results: Forty-two had confirmed bleeding complications (23%) and 11 (6%) required surgical intervention to control bleeding. Contributing factors included: concurrent aspirin – 31 and renal failure – 18. Complications included: cardiac re-operations - 5, non-cardiac re-operations - 3, gastrointestinal bleeding – 2, hematoma evacuation - 1 and multiple transfusions for arterio-venous fistulas, cardiac catheterizations, tracheostomies, pacemakers, and dialysis-related catheters.

Conclusions: Use of clopidogrel may have serious bleeding consequences for patients undergoing procedures. Until proper use of clopidogrel in the perioperative period is defined, surgeons should be aware of the bleeding risk and closely monitor these patients for bleeding.