Hi Doctor, I have been recommended to have a fusion at L4-L5 and exploratory at L5-S1 with possible fusion. My neurosurgeon has stated however that he will not do the surgery until I am off of plavix for 6 weeks. He stated that no neurosurgeon in his right mind would do the PLIF/exploratory until 6 weeks off plavix. My cardiologist says that 2 weeks is the current reccomendation. I am wondering if 6 weeks is the general rule for neurosurgeons? I am concerned about the 6 weeks as I have had stents close up in the past. Is the neurosurgeon being cautious due to this? Thank you for your help
This is not me or any other neurosurgeon who decide about the period of Plavix inactivation. This is the cardiologist who decides.
In urgent life threatening cases, ethically we should operate on the patient, so we ask the anesthesiologist to prepare Fresh Frozen Plasma (FFP) to inject during the surgery to minimize the bleeding, thats how we can normally operate on a patient without visuel difficulties in the operatory field.
I other cases we prepare fo eventuel infusion of 1 or 2 or 3 bags of Packed Red Blood Cells (PRBC).
Normally we can operate on a patient when Plavix is 6 to 9 days off (because after that period the damaged by Plavix platelettes being in continuouos decrease become much less and new effective ones are "born"), (taht does not mean that Plavix in the blood stream is absent, it will stay till 14 days but after 7-8 days it became not effective )
When the surgery in not urgent, I mean scheduelled, and should be done for pain relief
teh surgeon should do it after 10-16 days
When it is donse as a salvage surgery because a compressed nerve (fear from paralysis and extreem weakness) and we should do it " now " we STOP PLAVIX, AND SWITCH TO HEPARINE OR TO COUMADINE,
IN THE CASE OF HEPARINE WE CAN STOP IT THEN HOURS BEFORE SURGERY. IN CASE OF COUAMDINE 3 DAYS ARE SUFFICIENT..
PLEASE NOTICE THAT WHEN SURGERY IS A MOST IT SHOULD BE DONE AND ALWAYS UNDER SUPERVISION OF ANESTHESIOLOGIST.
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