Spinal anaesthesia despite combined clopidogrel and aspirin therapy in a patient awaiting lung transplantation: effects of platelet transfusion on clotting tests

Abstract

SummaryThe risk of central neuraxial blockade in patients treated with newer antiplatelet drugs is unclear. We report the case of a woman awaiting lung transplantation who presented for emergency groin surgery. She had recently undergone a coronary artery stent implantation and was treated with both clopidogrel and aspirin. Despite this dual antiplatelet therapy, uneventful spinal anaesthesia was administered following platelet transfusion. While thromboelastography was of no help in assessing the degree of anticoagulation, the effects of platelet transfusion were reflected by adenosine diphosphate and epinephrine aggregometry. Thus, in selected patients, platelet transfusion may be appropriate to enable central neuraxial blockade when deemed necessary.

Operative Delay for Orthopedic Patients on Clopidogrel (Plavix): A Complete Lack of Consensus

“…This patient had two collections of platelets given before neuroaxial anesthesia administration, which normalized the ADP aggregometry percentage. 24 As this survey only queried academic orthopedic training programs, its scope is limited. Orthopedic surgery residency directors do not set the policy of their program.…”

Regional anesthesia in patients of aged 99 years in clopidogrel use

“…Prodrugs are cleaved in vivo in the liver to active metabolites that antagonize the platelet receptor adenosine dinucleotide phosphate (P2Y12) and interfere with platelet activation and aggregation, an effect that cannot be antagonized, and is irreversible. It has a half-life of elimination of 120 h; however, its active metabolite is only 8 h.[114] The recovery of platelet function occurs 6–7 days after the end of administration. [17]…”

“…[12] Elderly patients usually have reduced physiological reserve, which can lead to postoperative complications,[3] delaying surgery in this group can lead to high mortality and morbidity where survival is higher in patients who have their operation performed on the day of admission, particularly in elderly >80 years. [4]…”

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“…It should be reiterated that platelet transfusions do not entirely reverse or negate the effect of antiplatelet agents . Blood was collected from patients already taking aspirin or clopidogrel and who had not undergone a diagnosed ischemic event in the previous 3 months.…”