Is one-month clopidogrel treatment only before major surgery is safe and feasible in patients undergoing percutaneous coronary intervention with drug-eluting stents?

Abstract

Background: Clopidogrel (Plavix®) is known to reduce early stent thrombosis. However, possible deleterious effects of 1-month clopidogrel treatment on hemostasis and stent thrombosis before major surgery in the setting of contemporary percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have not been fully investigated. Methods: Patients (pts) were randomly assigned with Sirolimus-eluting stent (SES, Cypher™), Paclitaxel-eluting stent (PES, Taxus™) or both before major surgery. After one-month administration of aspirin 100 mg and clopidogrel 75 mg after PCI, all pts were encouraged to discontinue 5 to 7 days before surgery and resume at postop 3 days unless there is significant risk of postop bleeding complications. In-hospital bleeding complications, stent thrombosis and adverse clinical outcomes were assessed. Results: A total 15 pts (Male; 10, Age; 62.8 ± 11 years) who underwent standard PCI with DES before major surgery were enrolled. A total 28 DESs (8-Cypher, 20-Taxus) were utilized to treat 28 lesions. All treated lesions are type B & C and 26.7% (4/15) of pts received more than 3 DESs. Mean DES diameter was 2.98 mm and mean DES length was 27.5 mm. Mean duration of discontinuation of aspirin and clopidogrel before surgery was 5.8 ± 1.1 days, after surgery was 4.4 ± 2.7 days and total duration was 8.3 ± 4.8 days. Forty seven percent (7/15) of pts underwent cancer surgery and mean duration from PCI to surgery was 44.6 ± 11.0 days. One pt suffered from post op wound oozing and received 2 units of transfusion (1/15, 6.7%). One pt showed CK-MB>2 X normal (1/15, 6.7%) and 2 pts mildly elevated B-type natriuretic peptide (BNP, 2/15, 13.3%) without manifested heart failure. There were no significant postop bleeding complications, acute and subacute stent thrombosis and adverse clinical outcomes. Conclusion: Only one-month administration of aspirin and clopidogrel after PCI with DES before major surgery, discontinuation 5 days before surgery and resume 3 days after surgery appears to be safe and feasible without significant bleeding complications, acute and subacute stent thrombosis or adverse clinical outcomes.