Shubert Daniel, Bono James, Nandi Sumon
Tufts University School of Medicine, Boston, Massachusetts.
J Surg Orthop Adv. 2015 Summer;24(2):115-9.
There is a known bleeding risk with administration of the antiplatelet drug clopidogrel, but in certain patients the likelihood of thrombosis is too high to cease its administration perioperatively. The risks of performing total joint arthroplasty in this population are unknown. An inpatient pharmacy database query identified seven patients who underwent eight hip or knee arthroplasties from 2007 to 2009 without perioperative interruption in clopidogrel administration. Bleeding-related events were recorded, including one inpatient death, one reoperation for infection, two 30-day readmissions, two antibiotic prescriptions for the incision, and blood transfusion administration during seven of eight admissions. The majority of bleeding-related events occurred following knee arthroplasty. Uninterrupted perioperative clopidogrel administration was associated with a high risk of bleeding-related events following total joint arthroplasty, particularly of the knee. Consideration should be given to delaying total joint arthroplasty until clopidogrel can safely be held in the perioperative period.
使用抗血小板药物氯吡格雷存在已知的出血风险，但在某些患者中，血栓形成的可能性过高，以至于在围手术期不能停止使用该药物。在这一人群中进行全关节置换术的风险尚不清楚。通过查询住院药房数据库，确定了7例患者在2007年至2009年间接受了8次髋或膝关节置换术，围手术期未中断氯吡格雷的使用。记录了与出血相关的事件，包括1例住院死亡、1例因感染进行的再次手术、2例30天内再次入院、2例针对切口的抗生素处方，以及8次入院中有7次输血。大多数与出血相关的事件发生在膝关节置换术后。围手术期不间断使用氯吡格雷与全关节置换术后，尤其是膝关节置换术后发生出血相关事件的高风险相关。应考虑推迟全关节置换术，直到围手术期能够安全停用氯吡格雷。
