Fri., 10/17/08 Geriatrics/Reconstruction, Paper #41, 4:46 pm OTA-2008
The Use of Clopidogrel (Plavix) in Patients Undergoing Non-Elective Orthopaedic Surgery
Jason A. Nydick, DO1 (n); Eric D. Farrell, MD1 (a-Synthes; e-DePuy);
Andrew J. Marcantonio, DO2 (n); Eric L. Hume, MD1 (a-Synthes; e-Stryker);
Shawn W. Storm, DO1 (a-Synthes); Robert Marburger, RN, CCRC1 (a-Synthes);
Robert F. Ostrum, MD1 (a-Synthes, e-DePuy, Biomet);
1Cooper University Hospital, Camden, New Jersey, USA;
2Lahey Clinic Medical Center, Department of Orthopaedic Surgery,
Burlington, Massachusetts, USA
Purpose: To assess the effects of Plavix on patients requiring non-elective orthopaedic surgery.
Patients and Participants: The orthopaedic trauma registry was used to retrospectively identify all patients taking clopidogrel (Plavix) (Bristol-Myers Squibb/Sanofi Pharmaceuticals, Bridgewater, NJ) who required non-elective orthopaedic surgery from 2004-2008. Twenty-five patients were identified on Plavix (PG) and thirty-two patients in the control group not taking Plavix (NPG). The groups were separated based on surgical delay. Patients taking Plavix with surgical delay < 5 days of the last dose (PG <5), (n=24) and surgical delay of > 5 days (PG>5) (n=1). An age and injury matched randomized control group not on Plavix, with surgical delay <5 days (NPG<5) (n=29) and delay >5 days (NPG>5) (n=3). A retrospective review was performed between the PG and NPG comparing pre and post-operative hemoglobin (Hb), blood transfusion requirements, surgical delay, thirty day mortality and post-operative complications. Statistical analyses were performed using the student’s t-test and chi square test to identify differences between the groups.
Results: The mean preoperative hemoglobin of the PG and the NPG was 11.2 g/dL and 12.3 g/dL (p=0.03). Transfusion rates were similar with 16/24 in the PG compared to 13/29 in the NPG (p=0.13). The mean surgical delay between the PG and NPG was 1.88 and 1.68 days (p=0.64). Overall complications between the PG and NPG was 8/24 and 9/29 (p=0.54). In both groups, 2 patients had post-operative wound drainage, which resolved without intervention. One patient in each group required revision surgery for nonunion. The 30-day mortality in the Plavix group was 0/24 (0%) compared to 1/29 (3%) in the control group (cardiac arrest) (p=0.37). There were too few patients taking Plavix who had a delay in surgery greater than five days to perform statistical analysis.
Conclusions: Avoiding surgical delay for patients on Plavix requiring nonelective orthopaedic surgery appears to be safe. The goal should be early operative intervention to decrease morbidity and mortality of surgical delay. This is especially true for patients with hip fractures, which is the most common orthopaedic surgery required of patients on Plavix.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.