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Preop Med Mgmt > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

Angioplasty

A

DAPT x 14 days

Surgery 48 h after PTCA (americans)

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2
Q

Factor Xa Inhibitors

Rivaroxaban

Apixaban

Edoxaban

A

Normal renal function CrCl > 30 mL/min

  • If neuraxial technique: Stop 3 days prior
  • If major bleeding risk: Stop 3 days prior
  • If no neuraxial technique AND/OR moderate or low bleeding risk: Stop 2 days prior
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3
Q

ASA & Vascular sx

A

Continue ASA

Surgery > 48 h preop: start 325 mg die

Surgery < 48 h preop: start 650 mg x 1

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4
Q

ASA - Primary prevention

A

Benefit: harm ratio less clear

Stop 7 days preop, especially if bleeding risk is high

Summary:

No impact for all-cause mortality

Small reductions in non-fatal MI & stroke over 10y

Low-quality evidence for decreased colonCA risk over 20y

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5
Q

ASA - Prevention, Secondary

low-dose < 100 mg/d

A
  • ACS: MI or unstable angina (within 30 d to 2 y)
  • Acute occlusive stroke (within 3 weeks to 2.5 y)
  • Stable ischemic HD and or PVD or carotid stenosis
  • PTCA

Stop ASA 7 d prior to:

spine, intracranial and opthalmology

Continue:

cataracts, cardiac (EP lab), carotid or peripheral vascular sx

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6
Q

Cilostazol (claudication)

A

Stop 4 d prior to sx

Half-life = 21h

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7
Q

Clopidogrel

A

7 days (if neuraxial or high risk bleed)

Low-bleeding risk: 5 d

P2Y12 receptor blocker

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8
Q

Dipyridamole

A

Stop > 4 days

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9
Q

dabigatran (pradaxa)

Direct Thrombin inhibitors

A

Normal CrCl > 50 mL/min:

  • Neuraxial or High bleeding risk: 3 days
  • No neuraxial, low-moderate bleeding risk: 2 days

Impaired CrCl 31-49 mL/ min:

  • Neuraxial or High bleeding risk: 5 days
  • No neuraxial, low or mod bleeding risk: 3 days
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10
Q

High bleeding risk

Ref: Douketis JD UpToDate 2020, Thromb Res 2003(108) 3-13

A
  • Anticipated difficulty in achieving hemostasis mechanically
  • Usually hemorrhagic surgery:
    • Involves highly vascular tissue or large blood vessels
    • brain, lung, kidney, prostate, oncologic, reconstructive sx, vascular, intrauterine & obstetric, arthroplasty, spine
  • Significant consequences of bleeding:
    • Lowers Hgb > 20
    • requires transfusion > 2U or surgery to correct
    • can be fatal
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11
Q

Low bleeding risk - definition

Sié, P & Samama, C et al: French study group Arch Cardiovascular Dis 2011(104), 669-76

A
  • Location non-critical
  • Low volume
  • Easily controlled with mechanical hemostasis
  1. Superficial surgeries (hernia, breast, skin)
  2. Diagnostic procedures (endoscopy)
  3. Minor dental: extraction, incision, simple implant
  4. Optho: cataracts, glaucoma sx
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12
Q

Moderate bleeding risk

Douketis JD UpToDate 2020, Thromb Res

A
  • Involves less vascular tissues or blood vessels of smaller caliber
  • Hemostasis achievable mechanically
  • Consequences of bleeding tolerable & not catastrophic
  1. Intraabdominal: usually less vascular or smaller vessels (chole, appy, gastrectomy)
  2. Opthalmologic sx (excl. cataract)
  3. Orthopedic (excl spine or arthroplasty)
  4. Intrathoracic (excl lung resection)
  5. Vascular: minor or endovascular procedures
  6. Rhythm device insertion
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13
Q

Prasugrel

A

7 days

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14
Q

Reversal of vit K antagonists

A

24-48h: vit K IV or PO 5-10 mg

Immediate:

  • FFP: how many units per INR increase?
  • 4 Factor PCC
  • 3 factor PCC & FFP (3F PCC lacks F VII)
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15
Q

Reversal: rivaroxaban, apixaban, edoxaban

A

4 or 5 factor PCC:

  • 2000 U or 25-50 U per kg
  • Once only dosing
  • Risk: thrombosis

Consider TXA

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16
Q

Reversal: Dabigatran

A

idarucizumab (Praxbind): 5 g IV

17
Q

ASA & DAPT for stents within last 12 mos

A

IF Neurosx, Post opthalmo sx, or prostate sx: Stop 7 days prior

Emergency NC sx: Minimum 4-6 weeks of DAPT, 6 wks preferred (BMS, DES) Continue ASA, stop P2Y12

Increased risk of MI & death 4 weeks post-stenting

Urgent sx: 4 weeks (BMS) or 3 mos (DES) of DAPT (BMS, DES), Continue ASA

Elective N-C sx: Minimum: 6 mos (BMS or DES), Continue ASA

Increased risk of MACE during 6 mos post-stenting

18
Q

Ticagrelor (Brillinta)

A

High bleeding risk or neuraxial: Stop 5 days prior

Low risk: minimum 3 days

P2Y12 receptor blocker

19
Q

Ticlopidine

A

10 days

20
Q

Warfarin

A

Stop 5 days preop (last dose day -6)

Preop Med Mgmt (13 decks)

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