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Principles of Anesthesia I - Summer 24 > Neuraxial - Anticoagulants/Antiplatelets & Considerations > Flashcards

Neuraxial - Anticoagulants/Antiplatelets & Considerations Flashcards

1
Q

Patho of Epidural hematoma

A
  • compression of spinal cord
  • ischemia
  • permanent neuro damage
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2
Q

Symptoms of Epidural Hematoma

A
  1. lower extremity weakness, numbness
  2. low back pain
  3. bowel/bladder dysfunction
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3
Q

Tx of epidural hematoma

A
  • surgical decompression w/i 8 hrs
  • EMERGENT
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4
Q

Cox-Inhibitors

MOA:

A

NSAIDs/Aspirin (antiplatelet)

  • inhibits cyclooxygenase - prevents formation of platelet aggregation of thromboxane A2 (TXA2 - plt aggregation)
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5
Q

Examples of High Cardiac Risk Surgeries (>5%)

A
  1. Emergency surgery (elderly)
  2. open aortic sx
  3. peripheral vascular sx
  4. long sx w/ significant vol. shifts/blood loss
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6
Q

Examples of Intermediate Cardiac Risk Surgeries (1-5%)

A
  1. Carotid Endarterectomy
  2. Head/neck sx
  3. intrathoracic/intra-abdominal sx
  4. ortho sx
  5. prostate sx
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7
Q

Examples of Low Cardiac Risk Surgeries (<1%)

A
  1. Endoscopic procedures
  2. cataract sx
  3. superficial sx
  4. breast sx
  5. ambulatory sx
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8
Q

Aspirin precautions:
* High & intermediate risk:
* low-risk, central neuraxial:

A
  • high & intermediate: hold 4-6 days
  • don’t have to hold w/ low-risk or central neuraxial
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9
Q

NSAID considerations (Ibuprofen, Naproxyn, Voltaren)

A
  1. high risk - hold 5 half-lives
  2. intermediate: consider holding for cervical ESI (epidural steroid injection) & stellate ganglion block
  3. low risk/central neuraxial: no precautions
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10
Q

Glycoprotein IIB/IIIA Antagonists (antiplatelets)
Drugs & MOA

A
  1. Tirofiban (Aggrastat)
  2. Eptifibatide (Integrillin)
  3. Abciximab (ReoPro)
    * MOA: inhibits plt aggregation via surface receptors
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11
Q

Glycoprotein IIB/IIIA antagonists

regional anesthesia guidelines

A
  • hold until plt function has recovered
  • Tirofiban & Eptifibatide - hold 4-8 hours
  • Abciximab - hold for 24-48hrs
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12
Q

Thienopyridine Derivatives (antiplatelet)
Drugs & MOA

A
  1. Clopidogrel (Plavix)
  2. Prasurgrel ( Effient)
  3. Ticlopidine (Ticlid)
  • MOA: inhibits plt aggregation by blocking ADP transferase
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13
Q

Regional Anes. Considerations

Hold time for Clopidogrel/Plavix

A

5-7 days

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14
Q

Regional Anes. Considerations

Hold time for Prasugrel (Effient)

A

7-10 days

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15
Q

Regional Anes. Considerations

Hold time for Ticlopidine (Ticlid)

A

10 days

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16
Q

Unfractionated Heparin MOA

A
  • potentiates antithrombin (enzyme inhibitor)
  • inhibits thrombin (factor II), IX, X, XI, XII
17
Q

Regional Anes. Considerations

Hold time for low dose Heparin (<5000u)

A

4-6 hrs

18
Q

Regional Anes. Considerations

Hold time for higher dose Heparin (>20,000 U daily)

A

12hrs

19
Q

Regional Anes Considerations

Hold time for therapeutic dose Heparin (>20,000 U daily or in pregnancy)

A

24 hrs

20
Q

Regional Anes Considerations

What should someone on UFH have drawn before central neuraxial?

Where do you want it?

A
  • Plt count (>100,000)
21
Q

LMWH Drugs & MOA

A
  1. Enoxaparin (Lovenox)
  2. Dalteparin (Fragmin)
  3. Tinzaparin (INNOHEP)
  • MOA: inhibits factor Xa
22
Q

Regional Anes. Considerations

LMWH general considerations

A
  1. ensure coag status looks normal
  2. no other blood thinners in use
  3. check plt count if on LMWH > 4 days
23
Q

Regional Anes Considerations

LMWH pre-block/cath placement
* prophylactic dose:
* therapeutic dose:
* consider checking:

A
  1. delay 12hrs after prophylactic
  2. delay 24hrs after therapeutic
  3. check anti-factor Xa activity in elderly or renal insufficiency
24
Q

Vitamin K antagonist Drug & MOA

A
  • Warfarin
  • MOA: impairs Vitamin K-dependent factors (2, 7, 9, 10)
25
Q

Regional Anes. Considerations

Vitamin K Antagonists

A
  • hold for 5 days
  • ensure normal INR <1.5
26
Q

Thrombolytic Agents Drugs & MOA

A
  1. TPA
  2. Streptokinase
  3. Alteplase
  4. Urokinase
  • MOA: activates plasminogen, cleaves fibrin, clot dissolution
27
Q

Regional Anes Considerations

Thrombolytic Agents

A

Absolute Contraindication to Neuraxial!

28
Q

Direct Oral Anticoagulants Drugs & MOA

A
  1. Apixaban (Elquis)
  2. Betrixaban (Bevyxa)
  3. Edoxaban (Lexiana)
  4. Rivaroxaban (Xarelto)
  5. Dabigatran (Pradaxa)

MOA: inhibits factor Xa

29
Q

Regional Anes. Considerations

Direct Oral Anticoagulants

A
  • d/c 72 hrs before
  • consider checking drug level or anti-factor Xa if <72hrs
30
Q

Herbal Therapies Drugs & MOA

A
  1. Gingko
  2. Garlic
  3. Ginseng

MOA: activates plasminogen (similar to TPA)

31
Q

Regional Anes. Considerations

Herbal Therapies

A

may continue w/o concern for hematoma
* proceed if not on other blood thinners

Principles of Anesthesia I - Summer 24 (14 decks)

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