Medical Director's Office Bulletin

Clarification Regarding Anti-Platelet/Anti-Coagulant Therapy

Date: May 17, 2011

To: All Workers' Compensation Medical Providers

This bulletin clarifies recommendations contained in the Neck Injury Medical Treatment Guidelines regarding the use of Clopidogrel and other anti-platelet/anti-coagulant therapies prior to diagnostic and/or therapeutic injections.

Section D.3.a of the Neck Injury Medical Treatment Guideline states:

"Relative contraindications to diagnostic injections may include: allergy to contrast, poorly controlled Diabetes Mellitus and hypertension. Drugs affecting coagulation may require restriction from use. The following are suggested time period restrictions:

• Aspirin – withhold for seven days;
• NSAIDS – withhold for three days;
• Clopidogrel – withhold for three days;
• Other anti-platelet therapy and anti-coagulants should also be addressed individually by a knowledgeable specialist."

The stated time frames for withholding anti-coagulant or anti-platelet medications prior to injections are "suggested time period restrictions." Patients who undergo any procedure where anti-coagulant or anti-platelet therapies may require restriction should have these medications appropriately evaluated and managed by the treating physician or identified specialist.

Please contact the Board's Bureau of Health Management at (800) 781-2362 if you have any questions.