Hey guys. Had a quick question. Can someone point me to good online source or book that would give insight on when heparin should be stopped or restarted before/after a procedure. The one i did was a trach with bleeding complications. Morgan and baby miller did not have much. An in depth look at it would be nice. Thanks guys.
heparin
- Thread starter hotdogz
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I think the ASA has some good reccomendations out there, not sure where to get them though.
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d/c warfarin 4 days prior to sx. check INR. start hep bridging therapy and stop 12 hours before sx. check INR, give vit K if greater than 1.5. after sx, if INRs are okay start hep at 6 hours after leaving room. sorry i can't give you a reference as this is what the surgeon i am working with does.
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If you are talking neuraxial procedures...
Per ASRA:
http://www.asra.com/publications/consensus-statements-2.html
Per ASRA:
http://www.asra.com/publications/consensus-statements-2.html
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Tofu nailed it. ASRA is the neuraxial anticoagulation resource.
For surgical procedures and heparinization well, its based on the surgeon and the anesthesiologist. We give heparin all the time intraop without people bleeding out. Wheather it be for dvt prophylaxis, graft patency, extracorporeal life support devices, etc.
For common knowlege poop: Heparin is gone in 5 hours (roughly 4.5 1/2 Lives) if there isn't liver or renal failure. Check a PTT if your feelin groovy.
As for trachs and bleeding, from what I've heard its a prominent enough consequence that one should be prepared for it all the time. It may or may not have had anything to do with the heparin (unless the guy had only been off a drip for a couple of hours).
Remember that heparin can cause thrombocytopenia as well...strangely enough I think protamine (heparin's reversal) can cause a functional thrombocytopenia.
For surgical procedures and heparinization well, its based on the surgeon and the anesthesiologist. We give heparin all the time intraop without people bleeding out. Wheather it be for dvt prophylaxis, graft patency, extracorporeal life support devices, etc.
For common knowlege poop: Heparin is gone in 5 hours (roughly 4.5 1/2 Lives) if there isn't liver or renal failure. Check a PTT if your feelin groovy.
As for trachs and bleeding, from what I've heard its a prominent enough consequence that one should be prepared for it all the time. It may or may not have had anything to do with the heparin (unless the guy had only been off a drip for a couple of hours).
Remember that heparin can cause thrombocytopenia as well...strangely enough I think protamine (heparin's reversal) can cause a functional thrombocytopenia.
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A paper that I came across on this issue is (if your question was about surgery)
"Anticoagulation management strategies for patients on warfarin undergoing surgery" by Amir K.Jaffer, MD Cleve Clin J Med. 2006 Mar;73 Suppl 1:S100-5
Maybe not the best but it's a start
"Anticoagulation management strategies for patients on warfarin undergoing surgery" by Amir K.Jaffer, MD Cleve Clin J Med. 2006 Mar;73 Suppl 1:S100-5
Maybe not the best but it's a start
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this is why i am glad i am doing a surgery intership. we always write to d/c hep drip 4 hours before scheduled or time. usually our lazy nursing staff gets the drip turned off around two hours before start time. but in all actuality i first assisted in a lap bilateral inguinal hernia - not a major abdominal case obviously - on friday we stopped the drip an hour and a half before the surg. INR 1.12. and really i noticed no difference in bleeding from the surgery side of the curtain. we are a little more anal for major abdomens but for your little cases a reasonable several hour window should be cool. with an inr of less than 1.5 of course.
maio
maio
