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Clopidogrel is Not Associated with Increased Risk of Bleeding Following Open Abdominal Aortic Aneurysm Repair
Jeanwan Kang, James Bena, Rebecca Kelso, Christopher Smolock, Daniel Clair.
Cleveland Clinic, Cleveland, OH, USA.

Objectives: In spite of the known benefits of antiplatelet therapy in vascular surgery patients, these medications, in particular clopidogrel, are often held during the perioperative period due to concern for increased risk of bleeding. We aim to study whether the use of antiplatelet therapy during the perioperative period for those undergoing open abdominal aortic aneurysm (oAAA) repairs is associated with increased bleeding risk.
Methods: Patients undergoing oAAA repairs in 136 hospitals between 2003 and 2015 were identified using the prospectively gathered Vascular Quality Initiative Registry. Those undergoing emergency operations or early (< 30 days) conversions from endovascular abdominal aortic aneurysm repair were excluded. Outcomes of 3 propensity-score-matched medication groups were compared using linear and logistic mixed models. End points included postoperative bleeding requiring return to the operating room, intraoperative blood loss, volume of blood transfusion, procedure time, and length of hospital stay.
Results: There were 4764 patients who underwent elective oAAA repair during the study interval. Of these, 1418 patients (29.8%) were not on any antiplatelet agents, 3000 (63.0%) were on aspirin (ASA) alone, and 346 (7.3%) were on clopidogrel with or without ASA at least 36 hours prior to oAAA repair. From this cohort, we identified 323 propensity-score-matched patients in the 3 medication groups. There were no differences in any outcome measures, including postoperative bleeding requiring return to the operating room (none 2.5%, ASA 2.2%, clopidogrel 2.2%, P=.92), intraoperative blood loss (none 1.9L, ASA 1.7L, clopidogrel 1.7L, P=.48), average number of units of packed red blood cells transfused (none 1.8 units, ASA 1.5 units, clopidogrel 1.5 units, P=.48), procedure time (none 250 min, ASA 246 min, clopidogrel 254 min, P=.69), or length of hospital stay (none 7 d, ASA 7 d, clopidogrel 7 d, P=.91). Patients in the no antiplatelet group tended to have higher rate of retroperitoneal exposure (none 33.4%, ASA 23.5%, clopidogrel 29.0%, P=.10) and distal anastomosis to iliac or femoral arteries vs distal aorta (none 60.8%, ASA 52.6%, clopidogrel 51.3%, P=.19), although neither were statistically significant.
Conclusions: Antiplatelet therapy has known benefits in vascular surgery patients, including those with recent coronary stent placement or carotid interventions. Continuing antiplatelet medications, including clopidogrel, during the perioperative period is not associated with significant increase in postoperative bleeding complications in those undergoing elective oAAA repairs.


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