Safety of carotid endarterectomy while on clopidogrel (Plavix)

Clinical article

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Many patients undergoing carotid endarterectomy (CEA) regularly take clopidogrel, a permanent platelet inhibitor. The authors sought to determine whether taking clopidogrel in the period before CEA leads to more bleeding or other complications.


The authors performed a retrospective, institutional review board–approved review of 182 consecutive patients who underwent CEA. Clinical, radiographic, and surgical data were gleaned from hospital and clinic records. Analysis was based on the presence or absence of clopidogrel in patients undergoing CEA and was performed twice by considering clopidogrel use within 8 days and within 5 days of surgery to define the groups.


Taking clopidogrel within 8 days before surgery resulted in no statistical increase in any measure of morbidity or death. Taking clopidogrel within 5 days was associated with a small but significant increase in operative blood loss and conservatively managed postoperative neck swelling. No measure of permanent morbidity or death was increased in either clopidogrel group.


Findings in this study support the safety of preoperative clopidogrel in patients undergoing CEA.

Abbreviations used in this paper: APA = antiplatelet agent; CEA = carotid endarterectomy.

Article Information

Address correspondence to: Peter Nakaji, M.D., c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, Arizona 85013. email:

Current affiliation for Dr. Starke: Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.

Please include this information when citing this paper: published online January 29, 2010; DOI: 10.3171/2009.12.JNS09707.

© AANS, except where prohibited by US copyright law.




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