Room 4: patient decides to stop plavix without permission

[geauxg8rs]

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what do you guys do with patients who decide to stop plavix (or other blood thinner) on their own?

Say you saw a patient and explained at the consult that you were going to check with cardiologist to make sure they were okay with holding plavix.

Then you hear from the patient that they want the injection because they decided that it was okay to stop plavix without permission.

Do you do the injection since they have been holding it?
Do you say no since you don’t have permission?
Do you do it but say if you pull this again I am going to dismiss you?
Something else?

 

[lobelsteve]

Risk on them. Free society. Do the shot.

 

[Dr. Ice]

What was the injection out of curiosity? I'm at the point where I'm not stopping ac for tfesi joints mbb based on Goodman's recent article

 

[painfree23]

He's a big boy. Made the decision to stop it on his own. Just document that he agrees to proceed and that he understands the increased risk of stopping the medication without consulting his cardiologist.

 

[painfree23]

What was the injection out of curiosity? I'm at the point where I'm not stopping ac for tfesi joints mbb based on Goodman's recent article

can you please copy pdf the article here? I read it when it came out, but don't have access to it anymore.

 

[Ducttape]

a cover your arse moment.

document that you never told the patient to stop, and send it to the cardiologist and PCP. it was not your intent and you never thought in a million years that the patient would stop the Plavix.



then do the shot. and write on his discharge instructions never to stop his Plavix without his cardiologist's direct consent.

 

[mdvol]

The problem I have is with patients that know we had them stop for previous injection, with cards approval - which took a few days and then they had to wait a few more days off the AC, so they call in and say I have stopped my Plavix for the last 5-7 days and need to get shot pronto. Always happens on full full day. Also I would love to hear thoughts right now on standard for stopping anti-coag for TFESI.

 

[SSdoc33]

The problem I have is with patients that know we had them stop for previous injection, with cards approval - which took a few days and then they had to wait a few more days off the AC, so they call in and say I have stopped my Plavix for the last 5-7 days and need to get shot pronto. Always happens on full full day. Also I would love to hear thoughts right now on standard for stopping anti-coag for TFESI.

there is no standard. SIS and ARSA still back stopping plavix and coumadin before any epidural. i stop them, but im waiting for a big guideline saying its ok to do so. id guess that most of use still do hold these meds.

as far as the vigilante who stops his blood thinners on his own: scold the patient, document it, then do the shot.

 

[Biohazard685]

I'm very risk averse and conservative, I wouldn't proceed with injection unless it was one of the low risk ones where stopping anticoagulation isn't necessary.