Clopidogrel Washout Neuraxial — FRCA Final MCQ

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EasyRegional AnaesthesiaClopidogrel Washout NeuraxialFRCA Final

A 55-year-old woman (ASA III) presents for an elective total hip replacement. She takes clopidogrel for a previous TIA. The surgeon is willing to wait for clopidogrel washout. If the plan is to perform a spinal anaesthetic, how many days must clopidogrel be stopped before neuraxial blockade?

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Correct answer: B — 7 days

Clopidogrel irreversibly inhibits the P2Y12 ADP receptor on platelets for their lifespan (~7-10 days). The Association of Anaesthetists (2013) recommends stopping clopidogrel at least 7 days before neuraxial blockade to allow sufficient regeneration of functional platelets (~30% of the platelet population is replaced). Some guidelines recommend checking platelet function with PFA-100 or VerifyNow before proceeding if there is any doubt about adequate recovery. The risk of clopidogrel cessation (thromboembolic event) must be balanced against the benefit of neuraxial technique.

Reference: Association of Anaesthetists – 2013 – Regional anaesthesia and coagulation; RCOA – 2023 – Regional module