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| The Safety of Thoracic Surgery in Patients Taking Clopidogrel (Plavix) |
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Robert J. Cerfolio, Ayesha S. Bryant, Douglas Minnich; Cardiothoracic Surgery, UAB, Birmingham, AL Objective: The objective of this study is to assess the safety of thoracotomy and video-assisted surgery (VATS) in patients who are taking anti-platelet therapy, clopidogrel (Plavix). Methods: An observational study of a consecutive series of patients who were taking clopidogrel sulfate (Plavix) or ticagrelor (Brilinta) on the day of surgery and each day postoperatively and who underwent general thoracic surgery. Post-operative outcomes were compared to historical contols (20 controls to 1 patient) that were matched for procedure and age. Results: There were 231 patients (220 controls) between 1/2009 and 8/2009 who met the inclusion criteria, 11 patients underwent surgery while on clopidogrel. The procedures performed were: open thoracotomy with lymph node resection and lobectomy in 6 patients (including en bloc chest wall resection in one), Ivor Lewis esophagogastrectomy in two and a median sternotomy with resection of an 8 cm thymic carcinoma in one. Epidurals were not used. Two patients had video-assisted thoracoscopic wedge resections. There was no intra-operative morbidity or significant bleeding. No patients were transfused intra-operatively or post-operatively. The average hospital length of stay was 4.5 days. Only one patient experienced a 30-day major adverse cardiac event (MACE). There were no significant differences in morbidity or mortality between the cases and the matched controls. Conclusion: The widely held belief that thoracotomy, esophagectomy, median sternotomy and VATS cannot be performed on patients taking anti-platelet therapy (clopidogrel sulfate, Plavix)is not true. Therefore, patients who have undergone recent coronary artery stenting do not have to come off of their anti-platelet therapy prior to surgery. This new finding may reduce the risk of post-operative cardiac events and it eases the pre-operative conversation between the cardiologist, anesthesiologist and surgeon prior to surgery. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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