Question about Pletal

[Gas]

Wanted to get some advice regarding Pletal and neuraxial blockade, specifically epidurals. Couldn't find anything on ASRA. Seems to me this drug reversibly inhibits platelets, like NSAIDs, and half life is 12 hours. I tell my patients they have to be off for 48 hours (4 half lives) before I perform ESI. Just wondering if anyone has any input. Thanks!

BTW, these forums rock!

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[Noyac]

I think it is treated like aspirin. No need to stop it b/4 any regional. it is not a common drug in my experience. maybe SDN will weigh in here.

 

[Tenesma]

Platelet aggregability returns to normal within 96 hours of stopping Pletal. ..

hope that helps - i tell my patients to be off it for 5 days for transforaminal/interlaminar - 3 days for facets/si etc...

unfortunately ASRA to my knowledge hasn't included pletal in their guidelines - they should

 

[Gas]

Thanks for the replies. I am the new guy at my group, so they made it my job to find out about this drug. I couldn't find anything on ASRA or literature search, so I tried the forums. I'll tell the group at the next meeting, and also spread the word about how helpful this website is.

 

[tussionex]

it is not a common drug in my experience. maybe SDN will weigh in here.

no, not common at all....i've never really seen any positive results. meh.
sdn will certainly be more eloquent!

 

[sdn1977]

Yep - its 96 hours or thereabout, due to active metabolites. One metabolite seems to have at least 50% of the PDEIII inhibition. The kinetics are dose proportional. Cilostazol & its active metabolites have an elimination half-life of approx 11 & 13 hours. But, they accumulate about 2-fold with chronic administration.

Therapeutically, you'll see platelet effects which will start start to diminish after 4-5 half lives of the parent drug & will be as close to gone by 96 hours. It doesn't always reflect elimination of the drug, rather response of platelet inhibition.

Its uncommon relative to some others, but I have a few who use it specifically for intermittant claudiation & it can be stopped without hypercoagulability. It is on some MediCaid formularies which make it a choice when other drugs might not be....