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OBJECTIVES: Patients with vascular disease are commonly in need for potent antiplatelet medical regimen whose impact on complications remains unclear. In this study we sought to determine the role of uninterrupted use of Clopidogrel on bleeding and perioperative complications in patients undergoing open extracavitary vascular surgical interventions.
METHODS: Consecutive patients (n=872) who underwent carotid endarterectomy, endovascular aneurysm repair, femoral and infrainguinal reconstructions or major amputations (n=1354 operations) were stratified on quintiles of propensity scores calculated as their probability to continue uninterrupted use of Clopidogrel in the perioperative period. The propensity score was calculated on the basis of operation type, demographics and comorbidities, including the revised cardiac risk index. Random effects linear, logistic, and poisson regression were used to model outcomes.
RESULTS: There was a trend for increased incidence of hematomas in the clopidogrel group (OR: 2.39, 95%CI: 0.99 to 5.8, P=0.052); however, the incidence of severe bleeding that necessitated takeback (OR: 0.75, 95%CI: 0.14 to 4.03, p=0.74) and the perioperative mortality and cardiac complications (OR: 0.99, 95%CI: 0.49 to 1.72, p=0.8) were similar. Furthermore, wound complications (OR: 1.14, 95%CI: 0.64 to 2.03, p=0.65), intraoperative blood loss (coefficient: 12.8, 95%CI: -54 to 29 cc, p=0.55), intraoperative blood transfusion (coefficient: -0.1, 95%CI: -0.3 to 0.11 units, p=0.4), postoperative blood transfusion (coefficient: -0.07, 95% CI: -0.35 to 0.2 units, p=0.6), and operative time (coefficient -10.4 minutes, 95%CI: -28.3 to 7.45 minutes, p=0.25) were all comparable between the groups. The postoperative length of stay (median 4 vs. 5 days, IRR: 1.15, 95%CI: 1.04 to 1.27, p=0.002) and the ICU length of stay (median 1 vs. 2 days, IRR: 1.24, 95% CI: 1.03 to 1.5, p=0.02) were longer in the Clopidogrel group. Interaction terms between age or procedure type and Clopidogrel for the above endpoints were all non-significant statistically.
CONSLUSIONS: Uninterrupted perioperative use of Clopidogrel in patients undergoing extracavitary vascular operations is associated with a marginal increase in hematoma formation and postoperative and ICU length of stay. Wound complications, cardiac complications, perioperative mortality, and perioperative transfusion needs are not affected by Clopidogrel administration. The above findings were consistent across all age groups and procedure types under investigation. On the basis of this data uninterrupted perioperative use of Clopidogrel is justified in patients undergoing the operation types we examined.