How long should a patient be off clopidogrel (Plavix) before performing a central neuraxial block?

How long should a patient be off clopidogrel (Plavix) before performing a central neuraxial block?

• A. 1 day
• B. 2 days
• C. 7 days
• D. 14 days

Answer: (C)

The main concept is that clopidogrel causes an irreversible block of platelet function. It prevents platelets from aggregating, and since this effect lasts for the lifespan of the platelets, normal platelet function returns only after new platelets are produced. That turnover takes about a week. In central neuraxial anesthesia, the risk of spinal hematoma is serious if the blood’s ability to clot is suppressed during needle placement or catheter manipulation. Therefore, to minimize this risk, clopidogrel should be withheld long enough for platelet function to recover, which is about seven days. The other intervals are either too short to allow recovery or more conservative than necessary.

The main concept is that clopidogrel causes an irreversible block of platelet function. It prevents platelets from aggregating, and since this effect lasts for the lifespan of the platelets, normal platelet function returns only after new platelets are produced. That turnover takes about a week. In central neuraxial anesthesia, the risk of spinal hematoma is serious if the blood’s ability to clot is suppressed during needle placement or catheter manipulation. Therefore, to minimize this risk, clopidogrel should be withheld long enough for platelet function to recover, which is about seven days. The other intervals are either too short to allow recovery or more conservative than necessary.