title: Management of a Patient with a Thoracic Epidural After Accidental Clopidogrel Administration.
abstract: We report a case of accidental clopidogrel administration in a patient receiving ongoing epidural analgesia postoperatively. The epidural catheter was removed 7 hours after the clopidogrel dose without incident. The onset of inhibition of adenosine diphosphate-induced platelet aggregation in healthy individuals has been reported at 12 to 24 hours after administration of a single 75-mg dose of clopidogrel. This case demonstrates the importance of understanding clopidogrel's pharmacology to avoid ordering unnecessary tests, which may delay catheter removal. Consideration of appropriate testing and limitations in the context of unintentional antiplatelet administration with indwelling neuraxial catheters is discussed.
authors.affiliation: From the *Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, California; and †Department of Anesthesiology, Veterans Affairs Palo Alto, Palo Alto, California.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hah
authors.forename: Kristen
authors.initials: K
authors.lastname: Noon
authors.forename: Abhishek
authors.initials: A
authors.lastname: Gowda
authors.forename: Carlos
authors.initials: C
authors.lastname: Brun
mesh_terms: D000244:Adenosine Diphosphate / Q000378:metabolism; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D002408:Catheters, Indwelling; D000077144:Clopidogrel; D020878:Device Removal / Q000379:methods; D006801:Humans; D008297:Male; D008508:Medication Errors; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D013908:Thoracotomy; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D013988:Ticlopidine