94-year-old lady for bladder Botox

Background

• Urinary incontinence
• Previous bladder Botox minimally successful
• CKD – Stage 2
• NIDDM
• Severe OSA – on CPAP
• Chronic Back pain – laminectomy in 2018

Issues

·       Extensive IHD – Multiple previous admissions with ACS requiring PCI. 

• Ischaemic cardiomyopathy – Recent Sestamibi: LVEF 36% and fixed LAD territory abnormality
• Type II MI and episode on non-sustained VT associated with anaemia (Hb=66).
• Suspected upper GI bleed as cause of anaemia. Conservative management by gastroenterologist. Aspirin ceased and clopidogrel continued.
• Cardiologist has advised she should continue clopidogrel and is ‘unsuitable for any procedure’ during recent anaesthetic clinic review at Maitland

Discussion

Management of antiplatelet agent

• Surgical team have requested 7 day-cessation of clopidogrel
• Discussed cardiac history with team, they are concerned regarding bleeding on clopidogrel but happy to recommence aspirin
• Is it appropriate to recommence aspirin in setting of suspected upper GI bleed?
• Previous bladder Botox performed on DAPT but team felt surgical bleeding was unacceptable. Uneventful GA. 
• Risk of further Type II MI with bleeding 

Plan

• Face to face review in clinic
• Liaise with gastroenterologist for advice regarding aspirin