From the Guidelines
Plavix (clopidogrel) should be held for at least 5 days before mole removal procedures to minimize bleeding risk, as recommended by the most recent and highest quality guidelines 1. When considering mole removal, the decision to hold Plavix should be made in consultation with both the dermatologist and the physician who prescribed the medication.
- The type of mole removal planned and the patient's underlying cardiovascular risk are crucial factors in determining whether to discontinue Plavix.
- For minor, superficial procedures with minimal bleeding risk, some providers may not require stopping Plavix at all.
- For more extensive excisions, discontinuing Plavix 5 days prior to the procedure is recommended to allow platelet function to normalize and reduce bleeding complications, as suggested by guidelines from the Society of Interventional Radiology and American Gastroenterological Association 1.
- After the procedure, Plavix can usually be resumed within 24-48 hours once adequate hemostasis is confirmed, balancing bleeding risk against thrombotic risk.
- Patients with recent stent placement, stroke, or acute coronary syndrome may require special consideration, possibly including bridge therapy or proceeding without discontinuation, and should be managed on a case-by-case basis, considering the latest recommendations from relevant guidelines 1. It is essential to inform all healthcare providers about all medications being taken, including over-the-counter drugs and supplements that might affect bleeding, to ensure comprehensive care and minimize risks.
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.
Plavix (clopidogrel) should be held before mole removals.
- The recommended duration to hold Plavix before surgery is 5 days.
- It is essential to restart Plavix as soon as possible after the procedure, once hemostasis is achieved 2.
From the Research
Plavix Hold Before Mole Removals
- The decision to hold Plavix (clopidogrel) before mole removals depends on various factors, including the patient's medical history, the type of procedure, and the risk of bleeding 3.
- Studies suggest that the risk of bleeding is higher in patients taking antiplatelet drugs like clopidogrel, but the risk of thrombosis is also a concern if these drugs are discontinued 4, 3.
- In general, for minor procedures like mole removals, the risk of bleeding may be low, and the benefits of continuing antiplatelet therapy may outweigh the risks 3, 5.
- However, the American College of Cardiology and the American Heart Association recommend that clopidogrel be discontinued for at least 5 to 7 days before procedures with a high risk of bleeding 6.
- A study published in 2021 found that concomitant aspirin use and long duration of clopidogrel therapy were definite risk factors for major bleeding 7.
- Another study found that discontinuing clopidogrel 7 days before surgery was not enough to negate the difference in reoperations for bleeding between patients taking clopidogrel and those not taking the drug 6.
Recommendations
- Patients taking clopidogrel should consult their doctor or cardiologist before undergoing any surgical procedure, including mole removals 3, 5.
- The decision to hold or continue clopidogrel should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history 4, 3.
- For minor procedures like mole removals, the risk of bleeding may be low, and the benefits of continuing antiplatelet therapy may outweigh the risks 3, 5.
- However, for procedures with a high risk of bleeding, it may be necessary to discontinue clopidogrel for a longer period, such as 5 to 7 days, to minimize the risk of bleeding 6.