No Need to Stop Clopidogrel for Catheter Procedures

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SAN FRANCISCO—Patients can safely continue on clopidogrel therapy while undergoing percutaneous tunneled catheter procedures, researchers reported at the 37th Annual Scientific Meeting of the Society of Interventional Radiology.

“We always run into this issue in our clinical practice. There is a risk of bleeding and so we wanted to see what the risks were,” said study investigator Gloria Salazar, MD, an interventional radiologist at Massachusetts General Hospital in Boston. “We found it is relatively safe.  However, you have to take into account the whole picture and see what other medications the patient may be on.”

The study findings are important because there is a need to define new treatment guidelines for catheter placement in the presence of anticoagulants, such as anti-platelets agents, in this patient population, Dr. Salazar said.

“Unfortunately, the renal patients have multiple comorbidities, and so we need to extend the indications for the procedure so they can be treated,” Dr. Salazar told Renal & Urology News. “We really want to work closely with the nephrologists and urologists on this. We want to try to allow the patients to stay on their medications as often as possible.”

Dr. Salazar and her colleagues retrospectively reviewed the medical records of patients who underwent tunneled central venous catheter procedures from March 2010 to November 2011 at a single institution while on clopidogrel. The investigators recorded patients' demographics, medications, procedure types and bleeding complications (prolonged hemorrhage, hematoma and blood product requirements).

During the study period, 62 procedures were performed on 30 patients (19 female, 11 male).  The mean age of the patients was 65 years. The procedures included 25 tunneled 14.5 F hemodialysis (HD) catheter placements, two small-bore catheter placements (5F-10F), 11 14.5 F HD catheter exchanges, and 22 HD catheter removals (same catheter size range as those that were originally placed).

All patients were on daily clopidogrel therapy in addition to 81 mg aspirin (37 patients); 325 mg aspirin (23 patients); and 2.5-5 mg warfarin (five patients).

All procedures were completed successfully, and the researchers observed no intraprocedural or post-procedural complications and no bleeding complications, which Dr. Salazar called “encouraging.”

“Oftentimes, we are limited when it comes to stopping medicines, and [the study] helps give us assurance that we are not going to have a thrombosis or another clinical problem for the patients.”

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