Clopidrogel & CNB

[jafo1964]

at our institute we do a lot of lumbar epidural for pain relief in patients with peripheral vascular disease waiting for surgery. These patients are usually on heparin, Clopidrogel and occassionally on low dose unfractionated heparin. Most of the anaesthesiologists out here seem not to worry about it and just do the epidurals and even get away with it. I recently quoted the ASRA recommendation and refused an epidural without stopping clopi for the recommended 7 days. Was met with usual disapproval of surgeons and nonchalance of collagues. Surgeons feel stopping clopi will risk the vascularity. They are willing to take risk.
What should we do in face of conflicting recommendation. Can the surgeons to take risk for potential parplegias that the anaesthetic technique may produce
regards
jafo.

[frontier]

hi,
  what we do & is recommended to stop clopidogrel 7 days before surgery,you are right.i don't know how surgeons advise & insist on continuing such potent antiplatelet drugs.evan unfrac.heparin is to be stopped.drugs like aspirin & NSAIDS can be continued in special situations as these are not that potent.now you are the better judge if you are encountering any sort of complications like epidural hematoma leading to paraplegia etc.one aticle i have attatched regarding indications & contraindications of regional  anaesthesia that will boost your morale.