Kramer Eyal, Hadad Eran, Westreich Melvyn, Shalom Avshalom
Department of Plastic Reconstructive and Aesthetic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Am Surg. 2010 Jan;76(1):11-4.
Clopidogrel, a new antiplatelet agent that irreversibly inhibits platelet aggregation, is widely used today. This prospective work was conducted to evaluate the safety of performing skin surgery on patients taking clopidogrel. Patients undergoing surgery for excision of skin or subcutaneous lesions under local anesthesia taking clopidogrel were the study group. The control group comprised 2073 historical patients who had undergone a similar procedure. Data collected included: age, sex, past medical history, medications, and late complications. Follow-up was done at 1 to 2 weeks and 3 to 6 months. There were 32 patients on clopidogrel, having 38 lesions removed. Of these, seven patients were on aspirin and clopidogrel combined. The groups taking clopidogrel, aspirin, and warfarin had significantly more males, were older, and had significantly more comorbid medical conditions. There was no significant difference in the incidence of any of the complications in any of the groups. This study shows that patients taking clopidogrel before skin surgery, though older and with more associated medical conditions, do not experience a greater rate of complications. We conclude that patients undergoing minor excisional cutaneous surgery should continue taking clopidogrel because there is no apparent risk for increased complications when good meticulous surgical techniques are used.
氯吡格雷是一种新型抗血小板药物，可不可逆地抑制血小板聚集，如今被广泛使用。这项前瞻性研究旨在评估对服用氯吡格雷的患者进行皮肤手术的安全性。在局部麻醉下接受皮肤或皮下病变切除手术且服用氯吡格雷的患者为研究组。对照组包括2073例接受过类似手术的既往患者。收集的数据包括：年龄、性别、既往病史、用药情况和晚期并发症。在术后1至2周和3至6个月进行随访。有32例服用氯吡格雷的患者，共切除38处病变。其中，7例患者同时服用阿司匹林和氯吡格雷。服用氯吡格雷、阿司匹林和华法林的组男性明显更多，年龄更大，合并症也明显更多。各小组中任何并发症的发生率均无显著差异。这项研究表明，在皮肤手术前服用氯吡格雷的患者，尽管年龄较大且合并症较多，但并发症发生率并未更高。我们得出结论，接受小型切除性皮肤手术的患者应继续服用氯吡格雷，因为在采用良好细致的手术技术时，并无明显的并发症增加风险。
