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Background: Clopidogrel is a common antiplatelet medication for patients with coronary, peripheral, and cerebrovascular disease. Many surgeons recommend cessation of Clopidogrel prior to surgery to avoid bleeding complications. Clopidogrel cessation however, is associated with an increased risk of thrombotic events up to 3 months after cessation. We review our experience with laparoscopic cholecystectomy in patients who remained on Clopidogrel in the perioperative period.
Methods: An IRB approved retrospective review of patients having laparoscopic cholecystectomy from 2008-2012 while on Clopidogrel was performed. Patient demographics, indication for surgery, ASA score, operative time, conversion to open cholecystectomy, estimated blood loss, length of stay, morbidity and mortality were reviewed.
Results: Thirty-one patients (13 women and 18 men) underwent laparoscopic cholecystectomy while on Clopidogrel. Sixteen were performed in an elective setting and fifteen were done as emergency/urgent operations. ASA score was 2 in four patients (13%), 3 in twenty-four patients (77%), and 4 in three patients (10%). Two patients (6%) were converted from laparoscopic to open cholecystectomy due to indistinct anatomy in acute cholecystitis. Average operating time was 71 minutes (27-129 minutes). Average estimated blood loss was 48 ml (1-300 ml). Morbidity was experienced in 22.5% of patients, and two 30 day mortalities occurred (6%) secondary to cardiovascular complications. Length of stay averaged 3 days (outpatient-15 days).
Conclusions: Laparoscopic cholecystectomy performed on patients taking Clopidogrel did not produce clinically significant operative blood loss. Conversion to open cholecystectomy, morbidity and mortality were higher in this patient population but appear to be more related to patient comorbidities than the effects of the Clopidogrel. Recommendations for Clopidogrel cessation prior to laparoscopic cholecystectomy should be reconsidered.