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Tuesday, April 28, 2009

Combination of Aspirin and Plavix Increase Risk of Infection After Bypass

A new study was just published in the Archives of Internal Medicine that found an increased risk of postoperative infection in patients undergoing bypass surgery who receive both aspirin and clopidogrel (Plavix).

We use both of these agents in combination to treat heart attacks and keep stents open. Both are "anti-platelet" agents which inhibits the function of the platelet and make it harder for blood to clot.

It has been known for some time now that patients on this combination therapy prior to surgery have increased risk of bleeding. Patients who bleed have a higher rate of infection. Therefore, the findings of this study are not surprising. In fact, the national recommendations are, if possible, to stop this combination therapy 5 days prior to surgery.

There is though some interesting and emerging date that the use of these agents
may interfere with some of the bodies natural response to sites of tissue injury and inflammation. Therefore, there may be more to this story than just just increased bleeding.

More studies will be needed to more better understand these findings.

For now, most patients should be off this combination therapy, as the guidelines recommend, prior to bypass surgery. However, there may be some instances where the therapy should be continued. I would discuss this with your physician if you are planning on having bypass surgery.

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