Plavix before epidural

[interjectionreflection]

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I usually hold plavix for 7 days before epidural. I have an elderly patient that does well with ESI but recently had a stent and cardio says to hold for 72 hours. I disagreed, suggested we wait until it's safer to hold plavix (after the dual therapy period). Cardiologist didn't seem happy with that wants a note from me again recommending 7 days. Looked online there's some things online that says maybe 5 days is ok but only in those with low bleed risk. before I write back, wanted to check in not missing anything does anyone do ESI by holding plavix less than 7 days?

Edit: the five says I found was for surgery not for elective outpatient epidural for pain

 

[MitchLevi]

Never stop blood thinners for a transforaminal epidural or caudal, and you can most likely do lumbar ILESI with a 25g needle on thinners as well.

So, do a TFESI and certainly do not stop the Plavix unless you want to potentially kill your patient, which is generally frowned upon.

 

[interjectionreflection]

Never stop blood thinners for a transforaminal epidural or caudal, and you can most likely do lumbar ILESI with a 25g needle on thinners as well.

So, do a TFESI and certainly do not stop the Plavix unless you want to potentially kill your patient, which is generally frowned upon.

It's a lumbar ILESI. I was thinking to wait until it's safe to hold for 7 days so prolly delay procedure

 

[Agast]

I always hold for 7. Even if the cardiologist says 5 days. I’m looking for confirmation they are healthy enough to hold plavix at all, and I will take the liability of the extra 2 days. If they are not cleared to do an injection I send them to PT first. No one died from radicular pain. Yes TFESI is less risky but the guidelines for neuraxial injections and blood thinners are the gold standard. Anecdotally, my colleague had an epidural hematoma form in the c-spine on a patient who wasn’t even on blood thinners.

 

[Dr. Ice]

Have stopped holding blood thinners for years for tfesi, never an issue

 

[callmeanesthesia]

I’d just cite the asra guidelines. Not sure holding plavix for 2 days would do anything at all.

 

[BobBarker]

LESI?
Just do a caudal on plavix. I have done them for years on plavix/eliquis/anything.

 

[interjectionreflection]

LESI?
Just do a caudal on plavix. I have done them for years on plavix/eliquis/anything.

We tried in the past didn't work. Been getting ILESI with really good response

 

[BobBarker]

Bil tfesi while on plavix then would be my choice.

 

[lobelsteve]

If stent placed in 6 mo or less, then holding Plavix is really bad idea.
TFESI on Plavix non-issue.