Crash crani and plavix

[MTGas2B]

So, popped my crash crani cherry last night. 62 year old Katrina transplant to the great northwest. Big ICH, big like I can see the shift on the CT from across the room. Rapid decline in mental status, seen at outside facility, sent to us. Supposedly purposeful movement, after my colleagues came to the ER to reverse her NMB. Comes to the OR for emergent craniotomy. Takes plavix, ASA, previous CVA, presumable occlusive. Otherwise normal coags. Good (but pavixed) platelet count 350K. Neurosurgeons want platelet transfusions, continually.

On these plavix folks any good evidence on speeding the reversal, or just improving outcomes? Are more platelets really gonna help? Any evidence anyone has run across on this, specifically in the neurosurg population.

Next case, same day, emergency burr hole for the evacuation of subdural hematoma. 86 year old, previous CVA, takes aspirin...

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[VentdependenT]

well the platelets the pt has are useless so gotta give ones that work. BUT there is unbound plavix floaten around and leaken outta organs to find and bind to those new platelets your giving.

so keep pumpen em in. you now have a viscosity issue (potentially) but youre gonna be dumpen in plenty of isotonic to help. regardless of this the patient has bigger issues eh.

your bleeding time measurement is surgical hemostasis.

 

[Lizard1]

i had an ortho guy ask me the same question - he wanted to do fix a broken hip but the pt was on plavix. couldn't really find much literature in my amateur search. i of course rec'd postponing as the pt was 150 yrs old, took her plavix the morning of, and broke her hip while chasing gofers

he ended up postponing it......until the end of the day then declared it an emergency as a CYA ?!?

but just thought of DDAVP - would that help? along with plt transfusion

 

[Noyac]

Basically all you can do is give plts in my experience. Just like Vent said.

 

[EV-Stentor]

i had an ortho guy ask me the same question - he wanted to do fix a broken hip but the pt was on plavix. couldn't really find much literature in my amateur search. i of course rec'd postponing as the pt was 150 yrs old, took her plavix the morning of, and broke her hip while chasing gofers

he ended up postponing it......until the end of the day then declared it an emergency as a CYA ?!?

but just thought of DDAVP - would that help? along with plt transfusion

Yep buddy this the way to go...no brainer here the new plt will replace dysfunctional ones and DDAVP will release much needed IIa/IIIb

 

[IsoGirl2707]

The general surgeons where I am will sometimes have us give platelets before surgery in a patient who has been off plavix for 7-10 days which does not make sense to me since the patient is off their plavix for the recommended amount of time. Does anyone have any thoughts on this practice? Is there new data on the management of patients on plavix?

Thanks

 

[VentdependenT]

Sounds like an unnecessary exposure to infectious diseases and transfusion reactions.