From the Guidelines
Holding Plavix (Clopidogrel) Before Left Heart Catheterization (LHC)
Plavix (clopidogrel) should typically be held for a period of 5 to 7 days prior to Left Heart Catheterization (LHC) to minimize the risk of bleeding complications during and after the procedure 1.
- The decision to hold Plavix should be made on a case-by-case basis, taking into account the patient's cardiovascular risk profile and the potential benefits and risks of interrupting antiplatelet therapy 1.
- The standard dose of Plavix is 75mg orally daily.
- For patients undergoing elective CABG, clopidogrel should be discontinued for at least 5 days before surgery to limit blood transfusions 1.
- However, in patients with a high risk of ischemic events, the benefits of continuing clopidogrel may outweigh the risks of bleeding, and the decision to hold the medication should be individualized 1.
- It is essential to weigh the risks and benefits of holding Plavix in each patient, considering factors such as the patient's cardiovascular history, current medications, and the urgency of the procedure 1.
From the FDA Drug Label
Talk with your doctor about stopping your clopidogrel tablets before you have surgery. Your doctor may tell you to stop taking clopidogrel tablets at least 5 days before you have surgery to avoid excessive bleeding during surgery.
The decision to hold Plavix (clopidogrel) before Left Heart Catheterization (LHC) should be made by the doctor, and it may be recommended to stop taking clopidogrel at least 5 days before the procedure to avoid excessive bleeding. 2
From the Research
Holding Plavix (Clopidogrel) Before Left Heart Catheterization (LHC)
- There is limited evidence regarding the specific management of Plavix (clopidogrel) before Left Heart Catheterization (LHC) 3.
- The decision to hold or continue antiplatelet therapy, including clopidogrel, before LHC should be individualized based on the patient's risk of thromboembolic events and bleeding complications 4, 5.
- Studies have shown that the risk of major complications related to diagnostic cardiac catheterization procedures, including LHC, is extremely rare 6.
- In patients undergoing percutaneous coronary intervention (PCI), a 600-mg loading dose of clopidogrel given in the catheterization lab after coronary angiography, but prior to PCI, may have similar clinical outcomes as routine 4- to 8-h pre-load 7.
- The American Society of Interventional Pain Physicians (ASIPP) guidelines suggest that the risk of thromboembolic events is higher than that of epidural hematoma formation with the interruption of antiplatelet therapy preceding interventional techniques, though both risks are significant 3.
- The guidelines also recommend that the decision to discontinue or continue antithrombotic therapy should be based on a comprehensive analysis of each patient and the risk-benefit analysis of intervention 3.