Clopidogrel and epidurals

April 2006 "Anaesthesia" has a survey by Pennefather et al. It finds that nearly half of UK anaesthetists would place an epidural in a patient of clopidogrel, and a third would place one on clopidogrel and aspirin. This is despite the American Society of Regional Anaesthesia recommending at least a 7 day clopidogrel-free period! It is not clear if this attitude to this potent antiplatelet drug is borne out of ignorance or considered informed opinion, but I find it quite extraordinary that when the risk of epidural haematoma may be as high as 1:1500 in postmenopausal women that UK anaesthetists would be pushing on with epidurals in antiplateleted patients. Can we at least be reassured that they usually do not have spinal haematoma?