From the FDA Drug Label
When possible, interrupt therapy with clopidogrel for five days prior to such surgery. Resume clopidogrel as soon as hemostasis is achieved.
Discontinuation of Plavix (clopidogrel) prior to hysteroscopy is recommended when possible, for at least 5 days before the procedure 1. This is to minimize the risk of bleeding during the surgery. However, the decision to discontinue clopidogrel should be made after considering the individual patient's risk of bleeding and the risk of cardiovascular events if the medication is stopped. It is essential to weigh the risks and benefits and consult with the patient's healthcare provider before making any decisions.
From the Research
Yes, you should typically stop Plavix (clopidogrel) before a hysteroscopy, as the most recent and highest quality study suggests that discontinuation of antiplatelet therapy may make little or no difference to mortality, bleeding requiring surgical intervention, or ischaemic events 2. The general recommendation is to discontinue Plavix 5-7 days prior to the procedure to reduce bleeding risk. However, this decision should always be made in consultation with both the cardiologist who prescribed the Plavix and the gynecologist performing the hysteroscopy. Some key points to consider:
- The timing of discontinuation depends on why the patient is taking Plavix - patients with recent coronary stents or high cardiovascular risk may require special consideration.
- After the procedure, Plavix can usually be resumed within 24-48 hours if there are no bleeding complications.
- Some low-risk diagnostic hysteroscopies might be performed without stopping Plavix, but this is case-specific.
- The reason for stopping is that Plavix inhibits platelet aggregation, which increases bleeding risk during surgical procedures.
- For patients at high thrombotic risk, bridging therapy with shorter-acting antiplatelet medications might be considered during the perioperative period, as suggested by a study on patients undergoing major lung resection 3. It's also worth noting that a study on general surgery procedures found that patients who took clopidogrel within 6 days before surgery had a higher percentage of significant bleeding after surgery requiring blood transfusion, but there were no significant differences in operative or postoperative blood transfusions, hospital stay, or mortality 4. However, the most recent and highest quality study 2 provides the best evidence for guiding clinical practice, and its findings should be prioritized when making decisions about discontinuing antiplatelet therapy before non-cardiac surgery.