Determination of residual antiplatelet activity of clopidogrel before neuraxial injections

H. T. Benzon*, R. J. McCarthy, H. A. Benzon, M. C. Kendall, S. Robak, P. F. Lindholm, P. G. Kallas, J. A. Katz

*Corresponding author for this work

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

Background. Guidelines recommend discontinuation of clopidogrel for 7 days before a neuraxial injection, while other directives suggest that 5 days might be adequate. We examined the time course of antiplatelet activity after clopidogrel discontinuation in patients undergoing epidural injections. Methods. Thirteen patients were studied at baseline, 3, 5, and 7 days after discontinuation of clopidogrel. P2Y12 determinations were performed using the VerifyNow® assay (Accumetrics, San Diego, CA, USA), and clot closure times with stimulation by collagen/epinephrine and collagen/adenosine diphosphate using the PFA-100® (Platelet Function Analyzer, Siemens Diagnostics, Deerfield, IL, USA). Repeated-measures ANOVA was used to evaluate P2Y12 platelet reaction units, PFA-100 closure times, and per cent P2Y12 inhibition values. Wilcoxons signed-rank test was used to compare the frequencies of ≥30, 11-29%, and ≤10% platelet inhibition between the baseline and subsequent sampling points after discontinuation of clopidogrel. Results. On day 3 after clopidogrel discontinuation, two subjects had ≥30, seven subjects had 11-29%, and four subjects had ≤10% platelet inhibition; the corresponding numbers were 0, 3, and 10 subjects on day 5 (P=0.04). There were no differences between the ≥30, 11-29%, and <10 platelet inhibition groups between days 5 and 7 (0, 0, and 13 subjects, P=1.0). PFA-ADP closure times were normal throughout the study period except in one patient. Conclusions. These findings support the recommendation that discontinuation of clopidogrel for 5 days allows >70 of platelet function and might be adequate before a neuraxial injection is performed.

Original languageEnglish (US)
Pages (from-to)966-971
Number of pages6
JournalBritish journal of anaesthesia
Volume107
Issue number6
DOIs
StatePublished - Dec 2011

Keywords

  • coagulation
  • complications
  • epidural

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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