Assessing the risk of clopidogrel-related bleeding complications in patients undergoing inguinal herniorrhaphy

Abstract

To date, no studies have investigated how the preoperative management of clopidogrel, an irreversible antiplatelet agent, influences the outcome following minor operative procedures. The purpose of this study is to determine if clopidogrel use within 7 days of inguinal herniorrhaphy increases the postoperative risk for bleeding-related morbidity or mortality. A retrospective chart review was performed of 46 patients on clopidogrel who underwent inguinal herniorrhaphy from 2004 to 2008. Patients were grouped based on the last administered dose of clopidogrel; <7 days (A) and ≥ 7 days (B). Of the 46 patients, 20 were in group A and 26 were in group B. No significant differences in operative blood loss, perioperative transfusion requirement, postoperative bleeding complications, intensive care unit (ICU) requirements, mortality, or 30-day readmission/reoperation rates were demonstrated between patients in groups A and B. Patients in group A had a significantly increased postoperative admission rate (65% vs. 15%, P = 0.0002) and increased mean hospital stay (1.0 vs. 0.15 days, P = 0.003). However, urinary retention, pain management, and the monitoring of other conditions accounted for over 80% of these admissions. One patient in group A (5%) developed a postoperative hematoma, which is consistent with the complication rate seen in the general population after inguinal herniorrhaphy. Overall, no difference in admission secondary to hematoma or postoperative bleeding was demonstrated. Clopidogrel use within 7 days of inguinal herniorrhaphy did not increase the risk for perioperative bleeding complications. No mortalities, readmissions, or ICU requirements occurred, regardless of the timing of clopidogrel cessation. The increased risk for hospital admission and length of stay seen in group A is likely to be attributable to nonbleeding-related patient factors rather than clopidogrel use. Thus, it may not be necessary to interrupt clopidogrel therapy prior to inguinal herniorrhaphy in high-risk patients.