ASRA spinal Plavix

[caligas]

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now they say 5-7 days.

Anybody using PRU or similar assay to make the call for the 5 days folks?

 

[PainDrain]

In that five day period do they take into account other potential factors like aspirin, toradol/NSAIDs, fish oil, ect that may influence bleeding? I am sure you are fine with 5 days but I am overly cautious when it comes to neuraxial and thinners.

 

[GaseousClay]

they also now state that you should wait 6 hours before pulling an epidural catheter for just SQ heparin 5000 BID. Seems way too conservative there.

 

[Psai]

they also now state that you should wait 6 hours before pulling an epidural catheter for just SQ heparin 5000 BID. Seems way too conservative there.

I wait 2 hours

 

[Sonny Crocket]

Is the case elective or urgent? If urgent , take into consideration the total picture and make your decision accordingly. They are guidelines, not rules.

 

[BLADEMDA]

now they say 5-7 days.

Anybody using PRU or similar assay to make the call for the 5 days folks?

Me. I use 5 days off plavix plus the Plavix Now test.

Determination of residual antiplatelet activity of clopidogrel before neuraxial injections † | BJA: British Journal of Anaesthesia | Oxford Academic

The important finding of this study is the lack of statistical differences between the P2Y12 PRU values, per cent platelet inhibition, and PFA-ADP closure times in patients undergoing epidural steroid injections at 5 days compared with the values at 7 days after discontinuation of clopidogrel. These data support the 2010 published guidelines of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine which suggest that 5 days of discontinuation of clopidogrel is adequate before a neuraxial block.8 The platelet inhibition as measured by the P2Y12 assay at day 5 after discontinuation showed inhibition of 29% or less, which is considered the level of a ‘semi-responder’.13 If minimal inhibition of platelet function is accepted before a neuraxial injection,15 similar to the recommendations of the different guidelines wherein patients on aspirin or non-steroidal anti-inflammatory agents or those with slightly elevated international normalized ratio values (1.4 or less) are acceptable for neuraxial injection,5–8 then values of 20% or less inhibition by the P2Y12 assay is probably acceptable for neuraxial blocks.

 

[BLADEMDA]

plavix and platelet inhibition assay, neuraxial recs

I'm still at 5 days like the thread above