clopidigrel and low risk chest pain

[dotcb]

For a patient that you anticipate to be low risk chest pain r/o, nonspecific EKG, and claims to have an aspirin allergy (and describes it in a way that makes you not give ASA), do you give a single dose of clopidigrel?

I generally haven't (due to it being indicated for the highest risk patients) but I know a few people who do. Wondered if there are any opinions on this?

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[Apollyon]

A single dose - as in 75mg? I thought you had to do a load of 300mg (or even 600).

 

[dotcb]

Yes - 300mg would be the dose.

 

[EMRAGE]

I think it would depend upon Dispo, which ultimately comes down to age and risk factors:

If the complaint was so benign that I was going to discharge the patient, I probably wouldn't.

If the complaint was serious enough that I was going to admit them for rule out, I probably would.

If I was ever unsure, I would simply ask the admitting physician for there input.

I think this is a great question, and look forward to other responses. I have no EBM to support the above, but I've found myself in this situation a few times and it seems decision came down to the Dispo.

RAGE

 

[EctopicFetus]

I can say that at the 3 hospitals I work in I definitely dont and no hospitalist or cardiologist has ever asked me to in low risk folks.

 

[WilcoWorld]

I don't have any EBM to answer this. My personal practice is not to do this in a "low risk" patient. However, if I chose not to give ASA to any chest pain patient I'll always document the reason.