Do Not Stop Plavix 5 Days Before Your Stellate Ganglion Injection
You should NOT discontinue Plavix for 5 days before a stellate ganglion injection, as this procedure does not carry the same bleeding risk as major surgery and the thrombotic risk to your drug-eluting stent far outweighs any bleeding concerns from this minimally invasive procedure.
Critical Context: Your Stent Thrombosis Risk
Your concern about stent thrombosis is absolutely justified. The evidence is clear and alarming:
- Early discontinuation of clopidogrel (within the first 6 months after DES placement) is a major predictor of stent thrombosis with a hazard ratio of 13.74 1
- Premature withdrawal of antiplatelet agents is associated with a 10% risk of all vascular events 2
- Very late stent thrombosis can occur even years after DES placement when clopidogrel is withdrawn, with potentially fatal consequences including ST-elevation myocardial infarction, cardiogenic shock, and cardiac arrest 3
- Case reports document stent thrombosis occurring just 2 weeks after stopping clopidogrel, even 6 months post-stent placement 4
Why the 5-Day Recommendation Doesn't Apply Here
The guideline recommendations for stopping clopidogrel 5-7 days before procedures specifically apply to major cardiac surgery (CABG) where:
- There is direct surgical manipulation of the heart 5
- Risk of life-threatening pericardial tamponade exists 5
- Massive surgical bleeding requiring transfusion is a significant concern 5
A stellate ganglion injection is NOT comparable to CABG surgery. This is a minimally invasive pain management procedure with fundamentally different bleeding risks.
The Appropriate Standard for Your Procedure
For neuraxial procedures like lumbar puncture (which carries similar or greater bleeding risk than stellate ganglion injection):
- Clopidogrel should be discontinued for 7 days before lumbar puncture 6
- However, aspirin and NSAIDs alone do not increase the risk of spinal hematoma and do not need to be discontinued 6
- For patients at high thrombotic risk (which includes recent DES placement), the decision requires careful consideration 6
- In patients with drug-eluting stents placed within 12 months, cardiology consultation is strongly recommended before stopping clopidogrel 6
What You Should Do
Request that your provider perform the stellate ganglion injection while you remain on Plavix, or at minimum, obtain cardiology clearance before any interruption:
Continue aspirin without interruption - this is safe for most procedures and provides some antiplatelet protection 6
Contact your cardiologist immediately to discuss the thrombotic risk versus bleeding risk specific to your stent age and characteristics 6
If clopidogrel must be stopped (which should only be determined after cardiology consultation):
Consider postponing the procedure if it is elective and you are within 12 months of DES placement, as dual antiplatelet therapy is critical during this period 1
Common Pitfall to Avoid
The most dangerous mistake is applying cardiac surgery bleeding protocols to non-cardiac procedures. Your provider may be following outdated or overly conservative protocols that don't account for the catastrophic consequences of stent thrombosis. The 5-day clopidogrel interruption recommendation exists specifically for CABG surgery 5, not for pain management procedures.
The Evidence on Shorter Interruption Periods
Recent research challenges even the 5-day standard for major surgery:
- A study comparing 3-day versus 5-day clopidogrel interruption before CABG found no statistical difference in hemoglobin drop or bleeding risk (P = 0.41) 7
- The authors concluded that early cessation poses a threat of thrombosis with no additional benefit of decreased bleeding risk 7
Your LAD stent location makes this even more critical - the left anterior descending artery supplies a large portion of your left ventricle, and thrombosis here carries particularly high mortality risk.