From the Guidelines
Plavix (clopidogrel) should be stopped at least 5 days before a high-risk endoscopic procedure in patients at low thrombotic risk. The decision to stop Plavix should be made in consultation with both the cardiologist and the proceduralist, weighing the individual patient's thrombotic risk against the bleeding risk of the specific procedure 1. This waiting period is necessary because Plavix irreversibly inhibits platelet function, and it takes about 5-7 days for the body to produce enough new platelets to restore normal clotting function.
- The exact timing depends on the procedure type and the patient's specific bleeding versus thrombotic risk.
- For high bleeding risk procedures, a longer discontinuation period may be recommended.
- For patients with recent coronary stents or high thrombotic risk, the discontinuation period might be shorter or Plavix might be continued through certain procedures.
- Other studies support the recommendation of stopping Plavix at least 5 days before surgery, including the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes 1.
- However, the most recent and highest quality study, the 2016 British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines, recommends stopping Plavix 5 days before high-risk endoscopic procedures in patients at low thrombotic risk 1.
From the FDA Drug Label
5.3 Discontinuation of Clopidogrel Discontinuation of clopidogrel increases the risk of cardiovascular events. If clopidogrel must be temporarily discontinued (e.g., to treat bleeding or for surgery with a major risk of bleeding), restart it as soon as possible. When possible, interrupt therapy with clopidogrel for five days prior to such surgery. Resume clopidogrel as soon as hemostasis is achieved.
The patient should stop taking clopidogrel for at least 5 days before a procedure to minimize the risk of bleeding. 2
From the Research
Stopping Plavix Prior to Procedure
- The duration for which a patient should stop taking Plavix (clopidogrel) prior to a procedure is crucial to minimize the risk of bleeding complications.
- According to a study published in 2019 3, Aspirin/Clopidogrel should be stopped more than 7-10 days preoperatively.
- A meta-analysis published in 2014 4 suggests that a minimum washout period of 5 days should be observed after the last dose of clopidogrel to minimize perioperative bleeding and bleeding-related complications, unless emergency indications exist.
- Another study published in 2005 5 discusses the use of antiplatelet agents and anticoagulants in the treatment of arteriosclerosis, but does not provide specific guidance on the duration for stopping Plavix prior to a procedure.
Considerations for Procedure
- The decision to stop Plavix prior to a procedure should be made in consultation with the patient's healthcare provider, taking into account the individual's medical history and the type of procedure being performed.
- A study published in 2015 6 highlights the importance of balancing the risk of bleeding with the risk of thrombotic events when making decisions about antiplatelet therapy in patients undergoing percutaneous coronary intervention.
- Another study published in 2004 7 notes that the risk of bleeding may be increased in patients treated with aspirin, a thienopyridine, and warfarin early after PCI with stent placement, emphasizing the need for careful consideration of the timing of antiplatelet therapy cessation.