At 3 Defc

[big boy]

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54 old female h/o smoking PVOD, previous aorto bifem bypass neg ischemia on stress echo, was on coumadin stopped 5 days for surgery. she presents for axillo femoral bypass.
any concerns regarding anti coagulation???? and how will you manage adequacy of anticoagulation.

 

[leopold stotch]

54 old female h/o smoking PVOD, previous aorto bifem bypass neg ischemia on stress echo, was on coumadin stopped 5 days for surgery. she presents for axillo femoral bypass.
any concerns regarding anti coagulation???? and how will you manage adequacy of anticoagulation.

excuse my ignorance. what is pvod?

 

[big boy]

excuse my ignorance. what is pvod?

PVOD- is peripheral vascular occlusive disease

 

[leopold stotch]

PVOD- is peripheral vascular occlusive disease

sorry, use to just pvd.

anything more to it than a heparin drip, post-op dextran. measure ptt certain intervals throughout case. i'm new at this, start anesthesiology in july, so cut me some slack.

 

[Noyac]

I'm stumped!
Unless there is something about her history that you are not giving me, I don't see any issues. Heparin 5000units intraop for the graft and +/- reversal with protamine.

Please enlighten me.

 

[big boy]

I'm stumped!
Unless there is something about her history that you are not giving me, I don't see any issues. Heparin 5000units intraop for the graft and +/- reversal with protamine.

Please enlighten me.

Just think about it. How does Heparin work. It combines with antithrombin 3 and then inhibits thrombin. That is the major mechanism of action.
So will it work in this case???? if it does not have a substrate to bind???

 

[leopold stotch]

Just think about it. How does Heparin work. It combines with antithrombin 3 and then inhibits thrombin. That is the major mechanism of action.
So will it work in this case???? if it does not have a substrate to bind???

why is there no antithrombin 3?

 

[bullard]

The title of the post is at 3 defc....the patient's got antithrombin III deficiency.

I was lost for a second too.

Anyway, I'd give fondaparinux.

 

[big boy]

The title of the post is at 3 defc....the patient's got antithrombin III deficiency.

I was lost for a second too.

Anyway, I'd give fondaparinux.

How will you know you are adequately anticoagulated

 

[Noyac]

wow I missed the title.
Now you could give AT3 and then heparinize the pt in the usual fashion.

 

[militarymd]

thrombin inhibitor

 

[Trisomy13]

thrombin inhibitor

i was thinking argatroban, lepirudin, etc.

do you have a preference Mil?

 

[militarymd]

i was thinking argatroban, lepirudin, etc.

do you have a preference Mil?

I haven't used them enough to have a preference....although I have used argatroban, and it seemed easy to use.

I like easy.

 

[stephend7799]

give higher than normal heparin if you want the heparin to work..

then get an act...keep giving heparin til you get the desired act

what am i missing... ?

 

[toughlife]

How will you know you are adequately anticoagulated

what was her INR?

Since she is ATIII deficient then replace it with at3 concentrate and then you should have no prob using heparin.

 

[Noyac]

what was her INR?

Since she is ATIII deficient then replace it with at3 concentrate and then you should have no prob using heparin.

or 2 units of FFP

 

[jetproppilot]

give higher than normal heparin if you want the heparin to work..

then get an act...keep giving heparin til you get the desired act

what am i missing... ?

Bingo.

 

[jetproppilot]

Just think about it. How does Heparin work. It combines with antithrombin 3 and then inhibits thrombin. That is the major mechanism of action.
So will it work in this case???? if it does not have a substrate to bind???

It DOES have substrate to bind.

Just not as much.

Give more heparin.