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DAPT Aspirin Clopidogrel Neuraxial — FRCA Final MCQ

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ModerateRegional AnaesthesiaDAPT Aspirin Clopidogrel NeuraxialFRCA Final

A 72-year-old man (ASA III) requires a below-knee amputation for critical limb ischaemia. He is on dual antiplatelet therapy (aspirin + clopidogrel) following a coronary stent 8 weeks ago. Regarding neuraxial anaesthesia, which antiplatelet management is correct?

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Correct answer: D — Stop clopidogrel for 7 days; aspirin can continue – then perform spinal

According to the Association of Anaesthetists guidelines (2013), aspirin at standard antiplatelet doses (75-150 mg) does NOT contraindicate neuraxial blockade. Clopidogrel requires a 7-day washout before neuraxial procedures (to allow regeneration of functional platelets). However, stopping clopidogrel 8 weeks after coronary stenting risks stent thrombosis. A multidisciplinary discussion (anaesthetist, surgeon, cardiologist) is essential to balance the risks. If clopidogrel cannot be safely stopped, general anaesthesia with peripheral nerve blocks (fascia iliaca, sciatic) is the alternative.

Reference: Association of Anaesthetists – 2013 – Regional anaesthesia and coagulation; ESC – 2017 – DAPT guidelines