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Does Plavix Interact With Epidural?

Posted on Sat, 17 Jun 2017

Question: 93 yr old Mom began plavix only 30 days ago....orthopedic doc wants to give her an epidural steroid injection in lumbar.
1...Is it too early for her to stop plavix for 7 days so she can get her epidural??
2... ..What should she watch for as far as the complications from epidural ? 3. Can she start back on plavix immediately after epidural???

Answered by Dr. Bhanu Partap (1 hour later)

Brief Answer:
It has to be stopped

Detailed Answer:
Hello Sir

I understand your concern for your mothers health and i would like to tell you that
PLAVIX is basically an anticoagulant which prevent blood from clotting (blood thinner).

1. No its fine and its important to stop 7 days before the epidural injection.

2. You should watch for any kind of numbness developing in the lower part of the body , any sign of local blood collection under the skin, difficulty in urination, headaches

3. It can be started back after 24 of the procedure after discussing with the anesthetist.

I hope this information will answer your queries. Feel free to ask if you have any more doubts.

Kind Regards
Dr Bhanu Partap

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Bhanu Partap (57 minutes later)

Dr can I please ask-- is it ok to stop plavix for the epidural steroid injection ( and then restart plavix after it) even if she has only been on the plavix for 30 days?? Is it too soon to stop it??

Answered by Dr. Bhanu Partap (10 minutes later)

Brief Answer:
No Its Fine

Detailed Answer:
Sir

Plavix needs to be stopped for a minimum of 5 to 7 days to avoid any excessive bleeding due to needle puncture. No its not too early.

Can you please let me know why she is taking PLAVIX and who prescribed her?

Kind Regards
Dr Bhanu Partap

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Bhanu Partap (8 hours later)

Mom is now 93. In 2013 she was on coumadin for atrial fib and she had a fall , hit her head, with subdural hematoma. Had surgery. Dr took her off coumadin ( risk of bleed)and began Multaq for atrial fibulation. She had been doing fine with the afib until 4 weeks ago when she developed tia signs( trouble getting words out she wanted to say,- one weak, limp arm, higher blood pressure) so he increased nifedipine for blood p , increased metoprolol, and put her on plavix becaure she uses a walker and is a fall risk. He was scared to have another fall while on coumadin. This was all done to keep risk of XXXXXXX stroke down and keep blood pressure down. She also takes metoprolol, hctz, and Multaq for stroke prevention . Comments???

Answered by Dr. Bhanu Partap (41 minutes later)

Brief Answer:
Hello again

Detailed Answer:
Thanks for providing me the details, first of all I want to tell you that if she is taking plavix for atrial fibrillation for stroke prevention then it's not recommended. As her CHAD2vas score is beyond 2 so only Coumadin/Warfarin derivatives are the recommended drug group for her for prevention of stroke and clot formation.

Yes it do have a slightly high risk of bleed.

But as now she is on plavix and if the epidural injection is very much required then it has to be stopped 5 to 7 days before hand.

Multaq is DRONADERONE which is basically an anti arrhythmic agent to prevent af.

Plavix is of no use in AF patients. Kindly discuss with your treating cardiologist regarding this for optimisation of medical treatment for her.

Kind Regards
Dr Bhanu Partap

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj