Dr Arjun Rajagopalan

BIOPSYBIOPSY

Dr Arjun Rajagopalan

BIOPSYWe know …

• Anti-platelet agents agents like clopidogrel are in very common use.

• Patients who are on these drugs pose a dilemma when an invasive procedure is planned: discontinuance might increase thromboembolic events while maintenance might increase bleeding risks.

We don’t know … • Can laparoscopic cholecystectomy be

performed safely without discontinuing clopidogrel?

Dr Arjun Rajagopalan

BIOPSY 1: Population

2: Indicator variable

Patients who had undergone

laparoscopic cholecystectomy while

on clopidogrel

4: Comparison

Matched cohort based on ASA score and

indications for surgery operated without

clopidogrel

X

36 36

Dr Arjun Rajagopalan

BIOPSY3: Outcome variable

Outcomes Clopidogrel (36)

No clopidogrel (36)

Operative time (mean - mts) 79 mts 66 mtsEstimated blood loss (mean - ml) 49 ml 47 mlLength of stay (days) 2.9 days 1.8 days30-day morbidity (%) 22% 42%

2: Indicator variable

On clopidogrel4: Comparison

No clopidogrel

No statistically significant differences

Dr Arjun Rajagopalan

BIOPSY METHODOLOGY

Type of study Observational

SAMPLING

Centre Teaching hospital, USA

TIme frame 2008 - 2012

Analysis Retrospective

A priori samplesize calculation -

Exclusions Not stated

Numbers72 patients

Clopidogrel group - 36 No clopidogrel - 36

COMPARISON

Controls Yes

Randomization ⛔️ Case control

Protocols/ training ⛔️

Comparability of groups Comparable: Age, BMI, sex, comorbidities

MEASUREMENT

Training -

Blinding -

Multiple observers -

Duplication -

The author(s) conclude … Laparoscopic cholecystectomy

performed on patients maintained on clopidogrel during the

perioperative period did not produce an increase in blood loss, operative time, 30-day morbidity,

or length of stay.