Jerah Nordeen, Alumna, Pharmacy Residency, Florida

October 28, 2014

Patients receive clopidogrel before surgery to lower the risk of blood clots. Considerable research had been done to find the best way to administer clopidogrel before a cardiovascular procedure. But, little evidence on the topic was available for neuroendovascular surgery. The goal was to learn more about appropriate dosing for patients undergoing those procedures, particularly patients who did not respond to the first dose they received.

What she found

In a review of 81 patients, Nordeen found that 21 percent were resistant to the effects of clopidogrel after the first dose. Most significantly, the study showed an increased trend toward death when a complication occurred after surgery in that resistant group compared to the nonresistant group.

Why it matters

Based on these study findings, Mayo Clinic care providers changed the way they administered clopidogrel before neuroendovascular procedures. Future trials based on the findings will investigate the long-term risks and benefits associated with customized dosing in patients before neuroendovascular surgery.

“This study was completed when there was very little literature about this topic,” says Nordeen. “After seeing our results, we determined that our processes benefitted our patients and were something other facilities could use, too. Since the study was published, I’ve had people from quite a few outside organizations contact me with questions about the research and our current practice. Being involved in this project was a wonderful learning experience.”

Presentation and publication

• Presentation, Neurocritical Care Society Ninth-Annual Meeting, September 2011.
• Journal of Vascular and Interventional Neurology, June 2013.