Kypho on aspirin 325?

[TuohyDriver]

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New attending here. Did a bunch of vertebral augmentation during fellowship. I have a patient who is clinically and radiographically a good kypho candidate. Fracture is 3-4 weeks old. 80-something year old female, osteoporotic, T12 fracture, on aspirin 325mg for coronary stent placed in 2022. Cardiology said cannot stop the aspirin for the procedure. Outside of the typical conservative measures and maybe MBB (I know controversial), is there anything else I can offer or any way to work around this? Intraop platelet infusion? She’s not the most robust human at baseline and this has nearly eliminated her mobility due to pain. I’m obviously concerned about her becoming frail quickly.

Just wanted some thoughts from those more seasoned.

Thanks!

 

[Orin]

New attending here. Did a bunch of vertebral augmentation during fellowship. I have a patient who is clinically and radiographically a good kypho candidate. Fracture is 3-4 weeks old. 80-something year old female, osteoporotic, T12 fracture, on aspirin 325mg for coronary stent placed in 2022. Cardiology said cannot stop the aspirin for the procedure. Outside of the typical conservative measures and maybe MBB (I know controversial), is there anything else I can offer or any way to work around this? Intraop platelet infusion? She’s not the most robust human at baseline and this has nearly eliminated her mobility due to pain. I’m obviously concerned about her becoming frail quickly.

Just wanted some thoughts from those more seasoned.

Thanks!

Document R/B and discussion with patient/cardiologist.
Proceed with the correct procedure for the problem.
Higher risk for stopping with immobility/pain causing a DVT

You can hold the ASA for 3-5 days to regain some functional platelets but still keep her mostly anticoagulated.
You can ask to drop to 81 mg to show some shared risk
You could CYA with platelets running while you do the procedure
You could just do the procedure and move on with the above documentation to CYA.

In addition to the voodoo of MBBs for VCFs, you left out the SPR PNS for VCF pain

Case report: Use of peripheral nerve stimulation for treatment of pain from vertebral plana fracture - PMC

Vertebral plana fractures are a severe form of compression fractures that can cause significant morbidity due to incapacitating pain. Due to the flattening of the vertebrae in a plana fracture, accessing the vertebral body transpedicularly can be ...

www.ncbi.nlm.nih.gov

Oh and don't forget to own the bone...

 

[Tboned]

From ASRA App.
Interested in hearing others thoughts

 

[callmeanesthesia]

Agree with Orin other than I wouldn’t infuse platelets.

Most likely: discuss with patient risk of bleeding/paralysis plus standard risks of procedure, document the severe functional deficit, and proceed if patient agrees.

 

[BobBarker]

I would just do the kypho on ASA.

 

[pmrmd]

ASA doesn’t matter for kypho.

 

[SSdoc33]

sigh.

platelet infusion? c'mon, man.

dont ever stop aspirin for any injection.

 

[Status Sciaticus]

sigh.

platelet infusion? c'mon, man.

dont ever stop aspirin for any injection.

sounds like an academic thing to do.

 

[PainMD23]

I agree with Bob. Do the procedure on ASA after discussion of r/b/a.

 

[lobelsteve]

Did one today. Will do it Tuesday if they dont hold it.

 

[SC Tian]

Did one today. Will do it Tuesday if they dont hold it.

show us the picture of the unipedicular kypho? I did a kypho and sacroplasty at the same time, wonder if I can bill both, especially the facility part? 😉

 

[lobelsteve]

I can log in to server tomorrow and see what pics were saved.

 

[lobelsteve]

show us the picture of the unipedicular kypho? I did a kypho and sacroplasty at the same time, wonder if I can bill both, especially the facility part? 😉

2nd Lenoss Osteopearl case. | Steven Lobel

2nd Lenoss Osteopearl case. L5 Fx after non-traumatic ground level fall. Patient agreed to Evenity so I felt a candidate for bone instead of cement. Pic by pic. 1: Good looking start. Nice collimation. Necessary secondary to Nevro SCS on left and bladder stim on right. 2. Hit the pedal...

www.linkedin.com

Sorry, had to get Brandon to upload to pacs.

 

[SC Tian]

2nd Lenoss Osteopearl case. | Steven Lobel

2nd Lenoss Osteopearl case. L5 Fx after non-traumatic ground level fall. Patient agreed to Evenity so I felt a candidate for bone instead of cement. Pic by pic. 1: Good looking start. Nice collimation. Necessary secondary to Nevro SCS on left and bladder stim on right. 2. Hit the pedal...

www.linkedin.com

Sorry, had to get Brandon to upload to pacs.

thanks for sharing, nice picture with Nevro inside😉, the oblique is about 30 degrees? almost like a discogram, with a beautiful balloon position, unfortunately, no cements 🙂

 

[lobelsteve]

thanks for sharing, nice picture with Nevro inside😉, the oblique is about 30 degrees? almost like a discogram, with a beautiful balloon position, unfortunately, no cements 🙂

Or fortunately no cement.

 

[Tboned]

Did you do the kypho on ASA 325mg or not??

This is not @lobelsteve ’s pony show

 

[lobelsteve]

Pon show update:
Requested handout for OP meds and NNT to save a life with kypho