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Flashcards in AC guidelines Deck (15)
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1
Q

Heparin monitoring:

A

aPTT

2
Q

Heparin-IV or subcutaneous -How long before na placement or catheter removal?
HOw long before you can give heparin AFTER na placement?

A

Delayed for 2-4 hours

Admin delayed one hour after NA placement

3
Q

Heparin for intraop systemic heparinization

A

Same recs as iv and subcut heparin. 2-4 hours following d/c of heparin before NA placement or catheter removal (In the OR)

4
Q

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:

A

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

5
Q

LMWH: how do you monitor?

A

Anti Xa, but it is not recommended as it is not predictive of the risk of bleeding

6
Q

LMWH: Delay needle instrumentation fro at least ___ following low dose LMWH and ___ following high dose LMWH

A

10-12 hours following low dose

24 hours following high dose

7
Q

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

A

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

8
Q

Post op 2x daily dosing LMWH:
Catheter removed when?
First post op dose?

A

Catheter removed at least 2 hours prior to first dose of LMWH
First LMWH post op happens 24 hrs post surgery

9
Q

Warfarin: delay NA until ____ Ensure that INR is ___ at time of removal. Monitoring?

A

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

10
Q

NSAIDS:

A

Not necessary to alter timing of anything

11
Q

Ticlodipine and Clopidogrel

A

Ticlodipine; avoid for 14 days

Clopidogrel: delay for 7 days after discontinuation

12
Q

Platelet GP 2b/3a receptor antagonists: First of all, what are their names lol

A

Abciximab, eptifibitide, tirofiban
Ab: delay for 24-48 hours after d/c
Eptifbiitde and tirofiban: delay for 4-8 hours after d/c

13
Q

Thrombolytics:

A

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

14
Q

Direct thrombin inhibitors and NA: what are their names?

A

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

15
Q

Selective Antithrombin 3 mediated factor Xa inhibitor:

A

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.

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