Plavix / Clopidogrel and cervical medial branch blocks and cervical radiofrequency neurotomy

[Ligament]

What is your opinion? Do you discontinue or continue Plavix for these procedures?

Attached are the most comprehensive guidlines I can find.

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[ssmallz]

For medial branch blocks, I think the risk of thrombolic event from discontinuing plavix would outway any bleeding event you would get with a 25g needle. The needle is small and you're not inside the vertebral column. I would think you'd likely be ok to proceed with an RFTC as well but I would still send em to cards or pcp to determine write a note saying it's ok to stop. It's more of a cya measure but I'm not looking to push the envelope on an elective procedure. Ideally I would send em to cards on the same day I order the MBB, that way by the time they are ready for RFTC I have the answer I need

 

[lobelsteve]

Unless I am inside the canal or a bone, I do not hold.
MBB/RF/joints, LTFESI. Continue.

 

[SSdoc33]

i dont stop any anti-coagulants for facet procedures. used to stop them for intra-articular facets, but now i continue.

still havent gone over to steve's realm of anti-coagulants and TFESI, but im heading in that direction

 

[callmeanesthesia]

Case by case basis, always discuss (and document!) risks/benefits especially when going outside published guidelines. I don’t stop for any MBBs anymore. For cervical RF, I use an 18g needle, and there is a theoretical risk of hitting the vertebral artery if the needle is advanced too far, so I will hold anticoagulants, with cardiology clearance, unless the patient is very high risk to do so - multiple PEs, fresh stent, major vasculopath, etc.

 

[gaseous_clay]

Anticoagulant and Antiplatelet Management for Spinal Procedures: A Prospective, Descriptive Study and Interpretation of Guidelines

Abstract. Setting. Epidural hematoma rarely complicates interventional spine procedures. While anticoagulant and antiplatelet drugs increase bleeding risk,

academic.oup.com

Decent read

 

[pmrmd]

What Steve said.