CCS typo??? "PRE"op thromboprophylaxis in surg???

[pre med 2014]

one of the ob/gyn surg CCS case says we need to order PREop thromboprophylaxis for an ob/gyn patient undergoing laparotomy for bilateral salpingo oophorectomy + hysterectomy 2/2 ovarian cancer, shouldn't it be POST-op prophylaxis? This must be a typo, I thought we automatically stop heparin (LMWH or UFH), warfarin prior to surg, even prior to any surgery in a patient who really needs to be on thromboprophylaxis like for example prior to a CABG in a patient with triple vessel disease

Is it because the risk of bleeding is so small w/ a gyn surgery vs a thoracic surgery. Naturally the patient could lose a lot more blood in open heart surg vs laparotomy. But I mean if we stop heparin prior to delivery cause of risk of epidural hematoma from a spinal block in labor, why would we do LMWH during a laparotomy?? Seems like risk of bleeding is higher...

I know stopping aspirin prior to surgery is an iffy area, but I was under the assumption we automatically stop anticoags prior to any surg, at least for CCS.

sorry if this seems like a dumb question, I am posting at the risk of embarrassing the medical community. I feel like this should be basic knowledge

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[Multiverse]

Yes, that's a typo. I know which case you're referring to. The very same sentence mentions compression devices, which would also by post-op. Don't get bogged down with little details for CCS. It's about getting the basic orders and not doing something that will seriously harm the patient.

 

[pre med 2014]

indeed, pre-op heparin does sound suspect the more and more I think of it.

I was just having a hard time accepting the fact I caught a CCS typo. Surely I had to have misread something. I'll just take this as a sign I should be ready for the CCS portion come exam day!

 

[gujuDoc]

one of the ob/gyn surg CCS case says we need to order PREop thromboprophylaxis for an ob/gyn patient undergoing laparotomy for bilateral salpingo oophorectomy + hysterectomy 2/2 ovarian cancer, shouldn't it be POST-op prophylaxis? This must be a typo, I thought we automatically stop heparin (LMWH or UFH), warfarin prior to surg, even prior to any surgery in a patient who really needs to be on thromboprophylaxis like for example prior to a CABG in a patient with triple vessel disease

Is it because the risk of bleeding is so small w/ a gyn surgery vs a thoracic surgery. Naturally the patient could lose a lot more blood in open heart surg vs laparotomy. But I mean if we stop heparin prior to delivery cause of risk of epidural hematoma from a spinal block in labor, why would we do LMWH during a laparotomy?? Seems like risk of bleeding is higher...

I know stopping aspirin prior to surgery is an iffy area, but I was under the assumption we automatically stop anticoags prior to any surg, at least for CCS.

sorry if this seems like a dumb question, I am posting at the risk of embarrassing the medical community. I feel like this should be basic knowledge

Exactly!!! In fact on real exam when you get a consult they don't ask you to also type procedure name in. its one or the other.

When in doubt read crush ccs