This commendable work by O’Riordan et al1 will undoubtedly be an invaluable guide for surgeons. However, due to variable individual response to clopidogrel,2 the decision to stop treatment with clopidogrel should be based on the level of platelet inhibition. Such patients can be identified and monitored using simple bedside assay.3 This variability in the antiplatelet activity of clopidogrel can be attributed to genetic polymorphism.4 Thus, those with low responses to clopidogrel whose bleeding risks are minimal but who are at higher risk of further major cardiovascular events5 can be offered surgery early, and potentially fatal cardiovascular complications can be avoided.
Kumar A, Roberts DH. Test Before You Stop. Arch Surg. 2009;144(8):787. doi:10.1001/archsurg.2009.142