Departments of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
Departments of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2014 Feb;29(2):325-8. doi: 10.1016/j.arth.2013.06.008. Epub 2013 Jul 12.
Limited research assessing risks of continued clopidogrel perioperatively in patients undergoing elective orthopedic procedures exists. Patients that underwent elective primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) from 2007 to 2012 while taking clopidogrel at the time of surgical evaluation were retrospectively identified. Patient demographics, last dose of clopidogrel, intraoperative blood loss, blood transfusion, and presence of 30-day adverse cardiac events (ACE) were collected. Of 142 patients meeting criteria, 24 (16.9%) patients remained on clopidogrel perioperatively. Patients that continued clopidogrel were more likely to receive a blood transfusion within 24 hours of surgery (31.8% vs. 7.7%; P=0.004) and during hospitalization (37.5% vs. 15.3%; P=0.02), but the incidence of 30-day ACE was not significantly different. Continuation of clopidogrel perioperatively for elective THA or TKA should be carefully considered.
针对接受择期骨科手术的患者继续使用氯吡格雷的围手术期风险，相关研究非常有限。本研究回顾性分析了 2007 年至 2012 年期间在手术评估时正在服用氯吡格雷的择期初次或翻修全膝关节置换术（TKA）或全髋关节置换术（THA）患者。收集了患者的人口统计学资料、氯吡格雷的最后一次剂量、术中失血量、输血情况以及 30 天不良心脏事件（ACE）的发生情况。在符合条件的 142 名患者中，24 名（16.9%）患者在围手术期继续使用氯吡格雷。继续使用氯吡格雷的患者在术后 24 小时内（31.8%比 7.7%；P=0.004）和住院期间（37.5%比 15.3%；P=0.02）更有可能需要输血，但 30 天 ACE 的发生率无显著差异。对于择期 THA 或 TKA，围手术期继续使用氯吡格雷应慎重考虑。
