AC guidelines Flashcards
Heparin monitoring:
aPTT
Heparin-IV or subcutaneous -How long before na placement or catheter removal?
HOw long before you can give heparin AFTER na placement?
Delayed for 2-4 hours
Admin delayed one hour after NA placement
Heparin for intraop systemic heparinization
Same recs as iv and subcut heparin. 2-4 hours following d/c of heparin before NA placement or catheter removal (In the OR)
Heparin-complete/CABG: How long to delay heparinization before NA instrumentation? removal of catheter should be delayed for how long? surgery delayed for how long? Monitoring:
IN complete/CABG:
Delay heparinization at least 60 min following Na instrumentation
Removal of catheter should be delayed for at least 2-4 hours and until normal coagulation is restored. Surgery delayed for 12-24 hours after traumatic needle placement
Monitoring: aPTT or ACT
LMWH: how do you monitor?
Anti Xa, but it is not recommended as it is not predictive of the risk of bleeding
LMWH: Delay needle instrumentation fro at least ___ following low dose LMWH and ___ following high dose LMWH
10-12 hours following low dose
24 hours following high dose
Post op dosing (once daily with LMWH)
Catheter removed ____ following last dose of LMWH with subsequent dosing reinstated at least ___ hours folloiwn gcatheter removal .
First post op dose of LMWH occurs ___ after surgery, with the second dose occuring no sooner than ____ hours after first dose
Cath removed 10-12 hrs following last dose of LMWH …reinstated at least 2 hours following removal
First post op dose 6-8 hours afer surgery
second dose no sooner than 24 hours after first dose
Post op 2x daily dosing LMWH:
Catheter removed when?
First post op dose?
Catheter removed at least 2 hours prior to first dose of LMWH
First LMWH post op happens 24 hrs post surgery
Warfarin: delay NA until ____ Ensure that INR is ___ at time of removal. Monitoring?
delay NA until INR returns to normal after the d/c of warfarin (ideally 4-5 days). Ensure that the INR is <1.5 at time of catheter removal.
Monitoring: PT/INR
NSAIDS:
Not necessary to alter timing of anything
Ticlodipine and Clopidogrel
Ticlodipine; avoid for 14 days
Clopidogrel: delay for 7 days after discontinuation
Platelet GP 2b/3a receptor antagonists: First of all, what are their names lol
Abciximab, eptifibitide, tirofiban
Ab: delay for 24-48 hours after d/c
Eptifbiitde and tirofiban: delay for 4-8 hours after d/c
Thrombolytics:
Safe interval for NA anesthetic placement or catheter removal is unknown. Fibrinogen may help guide mgmt since it is one of the last clotting factors to recover
Direct thrombin inhibitors and NA: what are their names?
Dabigatran: 72 hours (longer with renal impairment). Delay dosing for 2 hours following NA instrumentation or catheter removal. CONTRAINDICATED with indwelling catheter.
Lepirudin and Argatroban: Delay placement until direct thrombin inhibitor assay is <40 or a PTT is <40. Delay dosing for 2 hours following neuraxial instrumentation or catheter removal. CONTRAINDICATED with indwelling catheter
Selective Antithrombin 3 mediated factor Xa inhibitor:
Fondaparinux: 5-10 mg sq day: Delay for 72 hours after d/c (longer with renal impairment)
Delay dosing for 2 hours following NA instrumentationor catheter removal. contraindicated with indwelling catherer.
Fondaprinux <2.5 mg SQ day:
Delay for 48 hours (longer with renal impairment)
Delay dosing for 2 hours following NA instrumentationor catheter removal. contraindicated with indwelling catherer.
