Trigger Points and Plavix

[walterhall]

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I had an elderly patient today who wanted some trigger point injections, but she is on Plavix and covered in bruises… is it really worth a CVA to avoid a bruise?

Thoughts?

 

[lobelsteve]

No reason to hold Plavix for trigger point injection. Bruising is bruising. Not epidural hematoma. Same goes for joints.

 

[emd123]

I had an elderly patient today who wanted some trigger point injections, but she is on Plavix and covered in bruises… is it really worth a CVA to avoid a bruise?

Thoughts?

Absolutely not worth it to hold plavix for TPIs. Just let the patient know that if they're covered in bruises already, they'll be covered even more in bruises after TPI's on plavix.

 

[Jcm800]

ASA should be held for 14 days for a TPI, and done under MAC, in an ASC!

sound crazy? just as crazy as holding Plavix for a TPI...

 

[PinchandBurn]

No reason to hold Plavix for trigger point injection. Bruising is bruising. Not epidural hematoma. Same goes for joints.

TPIs yes.

Joints, concern for hemarthrosis? Granted we usually use a 27G needle...

 

[lobelsteve]

TPIs yes.

Joints, concern for hemarthrosis? Granted we usually use a 27G needle...

Old argument. You would rather risk hemarthrosis than death from MI or CVA. Risk benefit profile strongly favors not holding blood thinners.

 

[walterhall]

ASA should be held for 14 days for a TPI, and done under MAC, in an ASC!

sound crazy? just as crazy as holding Plavix for a TPI...

Ha…
I had an attending in residency that would do TPI in the OR under MAC… it was a 2 hour process for 45sec of injections.

 

[Jcm800]

Ha…
I had an attending in residency that would do TPI in the OR under MAC… it was a 2 hour process for 45sec of injections.

I must know more… what a clown/criminal.