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Surgical prep and care > Perioperative anticoagulation > Flashcards

Perioperative anticoagulation Flashcards

1
Q

How does anaemia impact peri-operative haemorrhage?

A
  • Increased bleeding during surgery
  • Poor wound healing
  • Higher morbidity and mortality if peri-operative haemorrhage occurs
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2
Q

How is anaemia managed pre-operatively for elective surgery?

A
  • Investigate and correct anaemia before surgery
  • Refer to pre-op anaemia clinic if not obvious
  • G+S; Xmatch for high bleeding risk procedures
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3
Q

Name four procedures with a high risk of bleeding

A
  • Cardiothoracic surgery
  • Urological procedures
  • Polypectomy
  • Liver/spleen operations
  • Vascular surgery
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4
Q

What is the diagnostic criteria for anaemia?

A

Low Hb count

  • <140g/L in males
  • <120g/L in females.
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5
Q

How is anaemia managed prior to emergency surgery?

A
  • X-match ± transfusion
  • Secure haemostasis in active haemorrhage
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6
Q

What is a group and save?

A

Blood sample taken to confirm patients blood group and any RBC antibodies.

This information is saved in case of need for transfusion.

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7
Q

What is a crossmatch?

A

Patient sample is crossmatched with a sample from a blood unit to ensure compatibility.

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8
Q

Name three medications that increase peri-operative bleeding risk

A
  • Aspirin
  • Clopidogrel
  • Warfarin
  • NOAC
  • Corticosteroids: GI bleed
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9
Q

What should always be checked for in cases of unexplained thrombocytopenia?

A

Disseminated Intravascular Coagulation (DIC)

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10
Q

Name two coagulation tests and state their use

A
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11
Q

Name three indications for a pre-op coagulation screen

A
  • Past Hx of unusual bleeding
  • Previous post-operative bleeding
  • Unexplained persistent menorrhagia
  • FHx of bleeding disorder
  • Unexplained thrombocytopenia
  • Emergency operations
  • Severe sepsis
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12
Q

Name two surgical procedures that can proceed without interruption of anticoagulation

A
  • Dental extraction
  • Cataract surgery
  • Minor skin procedures
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13
Q

What is the target INR for surgical patients on Warfarin?

How is this achieved prior to elective surgeries?

A

INR <1.5

Stop Warfarin for 5 days prior to elective surgery

Reduce INR with phytomenadione (vit K) if INR ≥1.5 in the day before surgery

‘Bridging’ therapy with LMWH if high risk of thromboembolism

Stop LMWH at least 24h prior to surgery

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14
Q

How are patients on warfarin managed in emergency surgery?

A

If surgery can be delayed 6-12h: IV phytomenadione (vit K)

If cannot be delayed: prothrombin complex + phytomenadione

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15
Q

List three indications for ‘bridging’ anticoagulation therapy

A
  • VTE within previous 3 months
  • AF with either:
    • Previous stroke/TIA within last 3 months
    • High CHA2DS2VASC score
    • Mechanical heart valve
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16
Q

Name two situations which have increased target INR for surgery

A

Target INR 3.0-4.0

  • Arterial disease
  • Older mechanical heart valves
17
Q

Which antiplatelet therapies can continue in surgery?

A
  • Aspirin only: majority of operations
  • Clopidogrel only: discuss with relevant department
18
Q

What is the surgical risk of stopping dual antiplatelet therapy?

A

50% mortality within 1st month after stents are placed

In emergency surgery: continue aspirin and interrupt clopidogrel 5-day prior if necessary

19
Q

When can warfarin be started post-op?

A

Evening of surgery or next day if there is adequate haemostasis

Due to slow onset of action

20
Q

Name three side effects of warfarin

A
  • Intracranial bleed
  • Epistaxis
  • Bleeding for injection sites
  • GI bleed
  • Teratogenic
21
Q

Name two LMWH drugs

A
  • Dalteparin
  • Enoxaparin
22
Q

Differentiate between UFH and LMWH

A
  • Both inhibit ATIII
  • Reversal: Protamine sulfate
  • UFH
    • Shorter half-life
    • Given IV (SC prophylaxis)
    • Variable action: APTT monitoring
  • LMWH
    • Longer half-life
    • Given SC
    • Predictable action: no monitoring.
23
Q

How is UFH and LMWH overdose reversed?

A

Protamine sulfate

24
Q

What is a rare but serious complication of heparin?

A

Heparin-Induced Thrombocytopenia

Commonly presents with VTE

25
Q

Name three DOACs

A
  • Dabigatran
  • Rivaroxaban
  • Apixaban
  • Edoxaban
26
Q

When should DOACs be stopped prior to elective surgery?

A
  • Normal renal function
    • Low risk elective: 24hr prior
    • High risk elective: 48hr prior
  • Renal impairment: 24-96hr prior

Surgical prep and care (10 decks)

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