Clopidogrel & Epidurals (Powerpoint)

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This document discusses the rare but devastating complication of epidural hematomas from neuraxial blocks. It focuses on the risk from clopidogrel, a drug that inhibits platelet aggregation. While the exact risk is unknown, guidelines recommend stopping clopidogrel 7 days before a procedure. The case report describes an 80-year-old woman who developed a T12/L1 epidural hematoma after inadvertently being given a clopidogrel dose 48 hours before her epidural was removed. Her neurology was not recovered despite a delayed diagnosis and treatment.

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platelets play an important role in cardiovascular diseases, the final event leading to ACS is a spontaneous atherosclerotic plaques which initiates a platelet response with platelet adhesion to vascular wall with activation and agregation and finally clot formation with clinical sequences od CV deaths, MI and myocardial ischemia and arrhythmias, so atiplatelet therapy is crucial in treatment of ACS, in the topic I review the traditional agents and new agents , focusing on guidelines and real world of their cinical uses .

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Potential benefits of dual antiplatelet therapy beyond 1 year after an MI has not been studied Patients with MI are at increased risk of RECURRENT ISCHAEMIC EVENTS Intensive secondary prevention is theoretically beneficial Finding an ideal drug with best risk-benefit ratio is a challenge TICAGRELOR --- Direct acting Not a pro-drug; does not require metabolic activation Rapid onset of inhibitory effect on the P2Y12 receptor Greater inhibition of platelet aggregation than clopidogrel --- Reversibly bound Degree of inhibition reflects plasma concentration Faster offset of effect than clopidogrel Functional recovery of circulating platelets within ~48 hours PLATO trial PEGASUS TIMI trial

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