Bladder botox, IHD

94-year-old lady for bladder Botox


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


·       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


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 


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