Have a complicated patient that was diagnosed with 60% SFA occlusion during our trial. They want to start her on a heparin gtt asap.
Therapeutic UFH (intravenous)
Preoperative intravenous (IV) UFH — Neuraxial anesthesia techniques may be used in patients who require therapeutic anticoagulation (activated partial thromboplastin time [aPTT] >1.5 to 2 times baseline level) with IV UFH if it is clinically acceptable to return to normal coagulation status for several hours both for epidural or spinal insertion, and for removal of a continuous catheter.
The following conditions must be met prior to placing a spinal or epidural and prior to removing a neuraxial catheter:
●Patient not on other drugs affecting hemostasis (including aspirin) [17]
●No underlying coagulopathy
●Heparin infusion stopped >2 to 4 hours; normal aPTT documented [13]
●If patient on heparin >4 days, normal platelet count documented (see "Management of heparin-induced thrombocytopenia")
Heparin should not be administered for one hour after a needle or catheter is inserted into the neuraxis space [17]. When spinal or epidural analgesia is used in conjunction with IV heparin, use of the smallest effective concentrations of local anesthetic will allow for earlier recognition should motor or sensory loss be caused by SEH. If signs and symptoms (numbness, weakness, back pain) of SEH are noted, emergent MRI and appropriate surgical consultation should be obtained, as neurologic recovery is more likely with surgical decompression within eight hours of symptom onset [13].
