Spinal anaesthesia despite combined clopidogrel and aspirin therapy in a patient awaiting lung transplantation: effects of platelet transfusion on clotting tests

The risk of central neuraxial blockade in patients treated with newer antiplatelet drugs is unclear. We report the case of a woman awaiting lung transplantation who presented for emergency groin surgery. She had recently undergone a coronary artery stent implantation and was treated with both clopidogrel and aspirin. Despite this dual antiplatelet therapy, uneventful spinal anaesthesia was administered following platelet transfusion. While thromboelastography was of no help in assessing the degree of anticoagulation, the effects of platelet transfusion were reflected by adenosine diphosphate and epinephrine aggregometry. Thus, in selected patients, platelet transfusion may be appropriate to enable central neuraxial blockade when deemed necessary.