Lavelle William F, Demers Lavelle Elizabeth A, Uhl Richard
Division of Orthopedic Surgery, Albany Medical College, Albany, New York, USA.
J Trauma. 2008 Apr;64(4):996-1000. doi: 10.1097/TA.0b013e3180485d23.
: Because of its irreversible nature, Plavix (clopidogrel) has become a double edged sword in the care of some of our sickest patients, particularly when surgical intervention is required. Platelets exposed to a single dose of clopidogrel are affected for the remainder of their lifespan and recover normal platelet function at a rate consistent with platelet turnover, which is within 5 days to 7 days (1-3) with the generation of new platelets not influenced by the drug; however, delay of surgical fixation for orthopedic patients, particularly patients with hip fractures may lead to increased morbidity and mortality.
: A Web-based survey was created and administered to the program directors of academic orthopedic surgery programs.
: Seventy-three percent of orthopedic residency programs responded that waiting 3 days or less for urgent but nonemergent operative interventions on patients on clopidogrel is acceptable with 23% feeling that no delay at all is necessary. For emergent surgery, the vast majority of programs 66 (89%) reported no delay to the operating room for patients on clopidogrel.
: The majority of orthopedic surgery residency programs who responded to the survey wait less than 3 days for urgent surgery and do not delay surgery for emergency cases for patients on clopidogrel. At this point we feel that an early intervention that occurs within approximately 2 days, with the acceptance of the possibility of increased blood loss is in the patient's best interest. Based on the reviewed physiology, a perioperative platelet transfusion may be of some benefit as the transfused platelets would be effective in forming a viable plug.
由于其不可逆的性质，波立维（氯吡格雷）在治疗一些病情最严重的患者时已成为一把双刃剑，尤其是在需要进行手术干预的情况下。暴露于单剂量氯吡格雷的血小板在其剩余寿命内都会受到影响，并以与血小板更新一致的速度恢复正常血小板功能，更新时间在5天至7天内（1 - 3），新血小板的生成不受该药物影响；然而，骨科患者，尤其是髋部骨折患者手术固定的延迟可能会导致发病率和死亡率增加。
创建了一项基于网络的调查，并向学术性骨外科项目的项目主任进行了调查。
73%的骨科住院医师培训项目表示，对于服用氯吡格雷的患者进行紧急但非急诊的手术干预，等待3天或更短时间是可以接受的，23%的项目认为根本无需延迟。对于急诊手术，绝大多数项目（66个，占89%）报告称，服用氯吡格雷的患者无需延迟进入手术室。
参与调查的大多数骨科手术住院医师培训项目对服用氯吡格雷的患者进行紧急手术时等待时间少于3天，对急诊病例不延迟手术。目前我们认为，在大约2天内进行早期干预，并接受失血增加的可能性，符合患者的最大利益。基于所审查的生理学知识，围手术期输注血小板可能会有一定益处，因为输注的血小板在形成可行血栓方面会有效。
