Plavix

[clubdeac]

Hey I think Steve mentioned this in a thread at one point but what is the risk of re-stenosis coming off plavix after the first year or of a stroke if coming off coumadin vs. risk of hematoma while on plavix or coumadin. Does anyone know the relative risk in each situation?

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[lobelsteve]

Would need to research Plavix. There is 6 mo, 12 mo data. Coumadin: cva risk in a fib is 4% per year without and 1% per year wth.

 

[PainDrain]

Would need to research Plavix. There is 6 mo, 12 mo data. Coumadin: cva risk in a fib is 4% per year without and 1% per year wth.

With plavix it also depends on the stent type. DES vs bare metal. I believe the current recommendations with DES is ASA and plavix indefinitely as it has been observed that late stent thrombosis occurs with ASA alone in fairly high numbers. Now the risk of spinal hematoma is likely low even in anticoagulanted patients but would you seriously risk it? It's indefensible in court under current society recommendations.

 

[lobelsteve]

With plavix it also depends on the stent type. DES vs bare metal. I believe the current recommendations with DES is ASA and plavix indefinitely as it has been observed that late stent thrombosis occurs with ASA alone in fairly high numbers. Now the risk of spinal hematoma is likely low even in anticoagulanted patients but would you seriously risk it? It's indefensible in court under current society recommendations.

Angry at all depends upon the procedure to be performed. If you are going in the canal with epidural or you're going near the canal with discography sympathetic block or kyphoplasty then you can't do this. But if you're doing a joint sacroiliac joint or medial branch block you're not in the canal and run no additional risk. I would find it indefensible to stop the medicine in those situations despite what astra says. I would .2 at ISIS and Aesop have to say or don't have to say.

 

[PainDrain]

Completely agree and in low risk joint injections the risks of stopping likely completely outweigh the bleeding risk in those who are high risk.

 

[geauxg8rs]

I used to stop blood thinners for all procedures because that's what we did in fellowship. Then I saw a patient come in for a follow up appt (from lesi, stopped med after cards okayed, had since restarted). She had trouble speaking, arm drift, etc. 911 to ER and she ended up having just a TIA and she recovered all function in the ER.
End of the story is that the patient was fine but I changed my practice patterns. Now I practice how Lobel describes.