pubmed.ncbi.nlm.nih.gov
It would be nice if SIS would create a real anticoagulant guidelines rather than just individual factfinders with softly worded "conclusions"
Never do anything regarding ASA or NSAID.
I think this is mostly a product of nursing influence. No matter what I say, it's a question about shellfish during the time out. Makes me hungry every time.
when they mention shellfish allergy I say, "good, more for me"
There are case reports in the literature of epidural hematomas forming after ESIs in patients on NSAIDS and concomitant SSRIs. Combination doubles risk of bleed compared to either alone
Case reports of epidural hematoma spontaneously. Your point being?
no not spontaneously Steve, after an epidural. Unless you're saying they were spontaneous and the fact they just had an epidural was coincidence. And I'm not saying to hold them however I would think twice if I were doing a cervical stim on a patient on chronic NSAID + SSRI.
By causing an MI or CvA?
how am I going to cause an MI/CVA?
I agree, I also do this.
b/c if a patient shows up and DIDN't stop the fish oil, then are you gonna cancel the procedure? if not, then they really didnt need to stop it in the first place. same rationale with nsaids and ASA.
I disagree. I see no reason not to stop NSAIDs. Fish oil obviously less important. I do cancel CESI with recent NSAID use. There is no medical benefit to continuing an NDAID.
thats insane. but you'll grow out of it.
Why would you do that?
I think only argument for live with dex would be to increase efficiency from med not getting siphoned away from target. But this can generally be done without live. In terms of vasospasm, if you see vascular, you've already stuck the vessel and injected, so does injecting more increase risk? Is vasospasm even a documented thing in lumbar?
Maybe I won’t cancel it, I’ve obviously done them in ibuprofen, but when I book the injection I go through meds and ask the person don’t take ibuprofen 24 hours before the injection. Just like how I go through why they are on ASA 81 and decide if there is an indication to continue for the injection. This is the most conservative thing to do. If they take the ibuprofen I advise them there is a small theoretical risk, and more likely than not just do the injection the day of.
first, there are actual case reports and documented risk of using nonparticulate steroids in TFESI. in a CME from ASA, there was a study showing increased risk of bleeding with concurrent NSAID use. i cant find the study, however.
that statement does not state that there is mandatory requirement for live fluoroscopy and clearly states that no live fluoro is needed when not using contrast.
