now they say 5-7 days.
Anybody using PRU or similar assay to make the call for the 5 days folks?
Anybody using PRU or similar assay to make the call for the 5 days folks?
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ASRA spinal Plavix
Started by caligas
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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
Is the case elective or urgent? If urgent , take into consideration the total picture and make your decision accordingly. They are guidelines, not rules.
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.
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