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Dr Arjun Rajagopalan
BIOPSYBIOPSY
Dr Arjun Rajagopalan
BIOPSYWe know …
• Anti-platelet agents agents like clopidogrel are in very common use.
• Patients who are on these drugs pose a dilemma when an invasive procedure is planned: discontinuance might increase thromboembolic events while maintenance might increase bleeding risks.
We don’t know … • Can laparoscopic cholecystectomy be
performed safely without discontinuing clopidogrel?
Dr Arjun Rajagopalan
BIOPSY 1: Population
2: Indicator variable
Patients who had undergone
laparoscopic cholecystectomy while
on clopidogrel
4: Comparison
Matched cohort based on ASA score and
indications for surgery operated without
clopidogrel
X
36 36
Dr Arjun Rajagopalan
BIOPSY3: Outcome variable
Outcomes Clopidogrel (36)
No clopidogrel (36)
Operative time (mean - mts) 79 mts 66 mtsEstimated blood loss (mean - ml) 49 ml 47 mlLength of stay (days) 2.9 days 1.8 days30-day morbidity (%) 22% 42%
2: Indicator variable
On clopidogrel4: Comparison
No clopidogrel
No statistically significant differences
Dr Arjun Rajagopalan
BIOPSY METHODOLOGY
Type of study Observational
SAMPLING
Centre Teaching hospital, USA
TIme frame 2008 - 2012
Analysis Retrospective
A priori samplesize calculation -
Exclusions Not stated
Numbers72 patients
Clopidogrel group - 36 No clopidogrel - 36
COMPARISON
Controls Yes
Randomization ⛔️ Case control
Protocols/ training ⛔️
Comparability of groups Comparable: Age, BMI, sex, comorbidities
MEASUREMENT
Training -
Blinding -
Multiple observers -
Duplication -
The author(s) conclude … Laparoscopic cholecystectomy
performed on patients maintained on clopidogrel during the
perioperative period did not produce an increase in blood loss, operative time, 30-day morbidity,
or length of stay.