What is the recommended washout period for Plavix (clopidogrel)?

From the Guidelines

The recommended washout period for Plavix (clopidogrel) is typically 5-7 days before elective surgery or invasive procedures with significant bleeding risk. This recommendation is based on the guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction, which suggest discontinuing clopidogrel 5 to 7 days before elective coronary artery bypass grafting (CABG) 1. For high-risk procedures such as neurosurgery or posterior eye surgery, a longer washout period of 7 days is preferred.

• The decision to discontinue clopidogrel should be made in consultation with a cardiologist, as premature discontinuation increases the risk of cardiovascular events.
• The washout period allows time for new platelets to be produced, as clopidogrel irreversibly inhibits platelet function for their lifespan (7-10 days).
• In emergent situations where surgery cannot be delayed, platelet transfusions may be considered to reverse the antiplatelet effect.
• Resumption of clopidogrel should occur as soon as hemostasis is achieved, typically within 24-48 hours after surgery, depending on the bleeding risk of the procedure. It's worth noting that the 2009 focused updates on the management of patients with ST-elevation myocardial infarction and percutaneous coronary intervention also provide guidance on the use of clopidogrel, but the recommendation for a 5-7 day washout period is based on the highest quality and most recent evidence available 1.

From the FDA Drug Label

When possible, interrupt therapy with clopidogrel for five days prior to such surgery. The recommended washout period for Plavix (clopidogrel) is 5 days before surgery, when possible. 2

From the Research

Plavix Washout Period

The recommended washout period for Plavix (clopidogrel) varies depending on the clinical context and the source of the guidelines.

• A minimum washout period of 5 days is often recommended before non-emergent cardiac surgery, such as coronary artery bypass grafting (CABG), to minimize perioperative bleeding and bleeding-related complications 3.
• However, some studies suggest that a shorter washout period may be acceptable in certain situations. For example, one study found that stopping clopidogrel 3 days or less before CABG did not result in a significant difference in hemoglobin drop compared to stopping it 5 days before surgery 4.
• The recovery of platelet function after discontinuation of clopidogrel maintenance dosing can vary depending on the individual patient and the level of platelet reactivity before study drug exposure 5.
• It's worth noting that the optimal duration for clopidogrel suspension prior to CABG is still a topic of debate, and large population studies are needed to validate the results 4.

Key Findings

• A washout period of at least 5 days is recommended before CABG to minimize bleeding risks 3.
• Stopping clopidogrel 3 days or less before CABG may not result in a significant difference in hemoglobin drop compared to stopping it 5 days before surgery 4.
• The recovery of platelet function after discontinuation of clopidogrel can vary depending on the individual patient and the level of platelet reactivity before study drug exposure 5.
• Dual antiplatelet therapy with clopidogrel and aspirin may be associated with reduced risk of major adverse cardiovascular and cerebrovascular events after CABG, without a significant increase in major bleeding 6.