Clopidogrel  & epidurals Dr John Zois
Epidural Haematomas <ul><li>Rare but devastating complication of Neuraxial blocks </li></ul><ul><li>Irreversible Neurology...
Clopidogrel Pharmacology <ul><li>A Thienopyridine,  increasingly  used for prevention of vascular events in pts with estab...
ASRA Guidelines (American society of Regional anaesthesia) <ul><li>Convened 2004 to form consensus on Neuraxials & Anticoa...
Case report <ul><li>BJA-Dec 2005 80y F post TKR -Pt normally on clopidogrel 75mg daily. Ceased 7/7 prior to surgery.  -Del...
Case report <ul><li>D0 -Complained of lumbar back pain </li></ul><ul><li>D1- Inadvertently administered single dose of clo...
Case report <ul><li>D3 -Epidural removed (48hrs post clopidogrel dose) with neurology still present. Again attributed to p...
Case report <ul><li>MRI= T12/L1 Haematoma Neurology never recovered.  </li></ul>
Discussion.. <ul><li>VCCAMM on Epidural haematomas - Incidence higher than initially thought Concern over frequently delay...
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Clopidogrel & Epidurals (Powerpoint)

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  • Clopidogrel: Benefits, Side effects

    posted on: sat,nov 2010
    posted by : manuheart123

    Clopidogrel is an antiplatelet agent, effective in inhibiting thrombus formation in arteries. It is very efficient drug for unhindered arterial circulation, where anticoagulants have minimal impact. The drug is specifically used to inhibit blood clots in the case of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. Clopidogrel is marketed only by the following multinational pharmaceutical companies; Bristl-Myers Squibb based in New York City, USA, and Sanofi-Aventis based in Paris, France, under the trade name Plavix as 75mg oral tablets.

    http://www.heart-consult.com/articles/clopidogrel-benefits-side-effects
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  • Clopidogrel & Epidurals (Powerpoint)

    1. 1. Clopidogrel & epidurals Dr John Zois
    2. 2. Epidural Haematomas <ul><li>Rare but devastating complication of Neuraxial blocks </li></ul><ul><li>Irreversible Neurology if evacuation not performed within 6-12hrs post Sx Onset </li></ul><ul><li>Exact Risk Uknown due to rarity ?1:150,000 Epidurals ?1:220,000 Spinals </li></ul>
    3. 3. Clopidogrel Pharmacology <ul><li>A Thienopyridine, increasingly used for prevention of vascular events in pts with established IHD </li></ul><ul><li>Selectively & Irreversibly blocks Platelet P2Y12 ADP Receptor -> Inhibits PLT aggregation </li></ul><ul><li>Max effect with 75mg dose @ 3-7/7 </li></ul><ul><li>Bleeding time increases 2x, returns to normal @10/7 </li></ul><ul><li>Use with aspirin for synergistic effects </li></ul>
    4. 4. ASRA Guidelines (American society of Regional anaesthesia) <ul><li>Convened 2004 to form consensus on Neuraxials & Anticoagulation </li></ul><ul><li>Exact risk of Haematoma with antiplatelet agents is unknown </li></ul><ul><li>No accepted lab test to determine bleeding risk </li></ul><ul><li>Recommend 7/7 cessation of Clopidogrel, 14/7 of Ticlopidine </li></ul>
    5. 5. Case report <ul><li>BJA-Dec 2005 80y F post TKR -Pt normally on clopidogrel 75mg daily. Ceased 7/7 prior to surgery. -Deltaparin 5000SC night prior to surgery (10hrs prior) as DVT prophylaxis -Atraumatic Lumbar CSE </li></ul>
    6. 6. Case report <ul><li>D0 -Complained of lumbar back pain </li></ul><ul><li>D1- Inadvertently administered single dose of clopidogrel </li></ul><ul><li>Physio noted numbness + weakness of NON operated leg and attributed to epidural analgesia </li></ul>
    7. 7. Case report <ul><li>D3 -Epidural removed (48hrs post clopidogrel dose) with neurology still present. Again attributed to persistent epidural block. </li></ul><ul><li>Neurosurg eventually consulted but 48hr delay until transfer to MRI capable centre </li></ul>
    8. 8. Case report <ul><li>MRI= T12/L1 Haematoma Neurology never recovered. </li></ul>
    9. 9. Discussion.. <ul><li>VCCAMM on Epidural haematomas - Incidence higher than initially thought Concern over frequently delayed diagnosis </li></ul><ul><li>Need to increase cessation period of clopidogrel to 10/7 pre op? </li></ul><ul><li>Remove Epidural immediately post inadvertent antiplatelets given delayed onset of action? </li></ul>

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