Continuation of Clopidogrel in Total Knee Arthroplasty: Perioperative Bleeding and Cardiovascular Outcomes in a Consecutive Case Series

Background Perioperative clopidogrel management in total knee arthroplasty (TKA) is challenging because interruption may increase thrombotic risk, whereas continuation may increase bleeding. Evidence remains limited. Methods We retrospectively reviewed 31 consecutive patients (35 knees) undergoing primary TKA while continuing clopidogrel 75 mg daily (April 2018–September 2019). A multidisciplinary team involving orthopaedic surgery, cardiology, and anesthesiology determined continuation. One senior surgeon performed all procedures using a tourniquet-free technique with intravenous and intra-articular tranexamic acid. All patients also received low-dose aspirin for at least 2 weeks postoperatively as venous thromboembolism prophylaxis. Outcomes through 90 days included bleeding, transfusion, wound complications, infection, major adverse cardiac and cerebrovascular events, symptomatic venous thromboembolism, and anesthesia-related complications. Results Mean age was 69 ± 6.4 years; mean estimated blood loss was 285 ± 95 mL, and mean hemoglobin decrease was 1.8 ± 0.6 g/dL. No transfusions or major bleeding occurred. Minor wound drainage followed 3 procedures (8.6%), and superficial cellulitis occurred in 1 knee (2.9%); no deep infections occurred. Four patients (12.9%) reported mild, nonspecific headaches; none met criteria for post-dural puncture headache. No clinical signs or symptoms suggestive of spinal hematoma or persistent neurologic deficit, and no myocardial infarction, stroke, or cardiovascular death, were observed. Conclusions Clopidogrel continuation during primary TKA may be feasible in carefully selected patients receiving multidisciplinary assessment and multimodal blood management. The small sample, retrospective design, and absence of a control group preclude conclusions about comparative safety.