CESI on Aspirin

[jwalker12]

Hey all,
How many of you are doing cervical interlaminar injections while the patient continues aspirin? If so are you doing it on 81mg and 325mg? It seems as if some people don't care much about the aspirin. I was trained to hold it for CESIs. Thanks!

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[lobelsteve]

Choose your guidelines to get your desired answer.

 

[paindoc007]

Also consider gauge of needle when deciding. 18 G tuohy; prob safer to hold. 22 g spinal? Maybe different story.

 

[callmeanesthesia]

I’m very conservative for CESI - I hold for 4 days if cardiovascular disease, 6 if they are just taking it for general health/primary prevention.

 

[lobelsteve]

Never held it from 2004-2014 using 18g Tuohy. Never held it from 2014 to current using 25g quincke and CLO.

 

[paindoc007]

Never held it from 2004-2014 using 18g Tuohy. Never held it from 2014 to current using 25g quincke and CLO.

Would you hold using 14g for scs?

 

[drusso]

Inject it.

 

[lobelsteve]

Would you hold using 14g for scs?

Nope.

 

[willabeast]

My opinion follows. When something bad happens with your CESI you look bad. Hematoma/infection/trauma to cord - whatever. Being on ASA messes with your platelets which cannot help any of those possibilities. Now if you take a patient off ASA they might suffer a CVA or M.I. Obviously a bad thing, but do you look bad? To put it another way, when you visit your patient in the ICU in your local hospital would you rather see cervical hematoma or would you rather see CVA as the admitting Dx ? BTW I am retired 3 years now 🙂

 

[painfree23]

Would you hold using 14g for scs?

Nope

 

[lobelsteve]

My opinion follows. When something bad happens with your CESI you look bad. Hematoma/infection/trauma to cord - whatever. Being on ASA messes with your platelets which cannot help any of those possibilities. Now if you take a patient off ASA they might suffer a CVA or M.I. Obviously a bad thing, but do you look bad? To put it another way, when you visit your patient in the ICU in your local hospital would you rather see cervical hematoma or would you rather see CVA as the admitting Dx ? BTW I am retired 3 years now 🙂

You look bad. And guilty. Bleed fixes with surgery. Death from MI does not. Seen it. Testified for it.

 

[Orin]

It's the sin of commission vs omission

Most will happily plead that the guidelines dictate X/Y/Z even though for the individual patient the better option is A/B/C

 

[deleted131481]

Fellowship we never held it, in current practice holds 5-7 days.

I currently ask to hold aspirin for primary prevention only for interlaminar. I won't cancel if they took it though. I try to document any discussion of blood thinners.

 

[HiddenGentleman]

I don't hold asa for anything.

 

[soccrwz]

would you think twice 325 vs 81mg?

 

[clubdeac]

I’ve never held either dose

 

[Ducttape]

My opinion follows... To put it another way, when you visit your patient, would you rather see him in the ICU in your local hospital for cervical hematoma or would you rather see MI on the death certificate ?

changed it for you...

 

[Ferrismonk]

ASRA Guidelines say stay on aspirin for CESI, stop for SCS. Other guidelines are less restrictive.

 

[Baron Samedi]

ASRA Guidelines say stay on aspirin for CESI, stop for SCS. Other guidelines are less restrictive.

The 2016 guidelines say ILESI is "intermediate risk" and put ASA as "shared risk assessment and risk stratification"...meaning do whatever you want.

If its primarily prophylaxis I hold it for 6 days, if its secondary prophylaxis, I don't hold it and document bleeding risk.

 

[SSdoc33]

our societies have really dropped the ball on anti-coagulation guidance.

i personally think it is insane to stop ASA for anything.

we have some of us stopping ASA and NSAIDS, others who do ESIs on patients on plavix and coumadin

 

[SommeRiver]

The 2016 guidelines say ILESI is "intermediate risk" and put ASA as "shared risk assessment and risk stratification"...meaning do whatever you want.

If its primarily prophylaxis I hold it for 6 days, if its secondary prophylaxis, I don't hold it and document bleeding risk.

You're aware of the guidelines changing in 2018?

 

[painfree23]

You're aware of the guidelines changing in 2018?

Link

 

[deleted131481]

You're aware of the guidelines changing in 2018?

Not that different. 2018 guidelines:

"If ASA is being taken for primary prophylaxis, ASA discontin- uation is recommended for high-risk procedures in which there is a heightened risk of perioperative bleeding and sequelae. In addition, consideration should be given to the discontinuation of ASA for certain intermediate-risk procedures, including inter- laminar cervical ESIs and stellate ganglion blocks, where specific anatomical configurations may increase the risk and conse- quences of procedural bleedin"

Secondary ppx.. again shared risk assessment.

A bunch of caveats, shared risk assessment, etc.

 

[SommeRiver]

I'm only mentioning there are new guidelines available. No one should stop aspirin.

 

[painfree23]

literally this should not be a thread. aspirin is NOT a risk factor for ANY injection we do.