Does anyone feels that plavix (clopidogrel). should typocally never be stopped for elective surgery ? under what conditions would you allow your patient to stop

Risk benefit ratio: Complications from disease being treated to nature of surgery and to have meaningful discontinuance like fourteen days prior to surgery. Long time w/o meds.

Needs to be stopped: Plavix should be stopped for most procedures if there is no contraindication. Performing surgery on patients on Plavix can lead to profuse bleeding. If it cannot be stopped, then the risk benefit ration of undergoing a procedure should be carefully evaluated. You can always anticoagulate with Lovenox (enoxaparin) in the periop period.

After 9-12 months: It depends on what the indication for Plavix (clopidogrel) is. The literature on Plavix (clopidogrel) shows benefits in preventing clots within stents for the first 9-12 months after stenting. As far as I have seen, there is no contraindication to holding Plavix (clopidogrel) for 2 weeks prior to surgery after the first year. From a surgeon's perspective, it needs to be held when it can be.

Stents?: If they have a cardiac stent, i believe the recommendation is not to stop the Plavix (clopidogrel) for 12 months post-stent. Your local cardiologist can help with this.