Thoughts?

[onechance]

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Would like to take your opinion on the following situation -
We asked for clearance from a patient's cardiologist regarding transitioning full ASA to 81 ASA prior to procedure.
Got the clearance but from his Nurse practitioner, with no countersignature from the physician himself.
Just wondering from a medicolegal standpoint:how reliable is this clearance?
Any thoughts/ advice will be greatly appreciated.

 

[NJPAIN]

Not a problem. She practices in collaboration with the cardiologist. I don't think a counter signature is required

 

[BobBarker]

81mg ASA still inhibits the platelets, right?

 

[clubdeac]

why take anyone off asa

 

[oreosandsake]

I need to take another look at the new ASRA guidelines that just came out... isn't there something for ASA 325 mg?

I thought they did some form of risk stratification...

google isn't pulling it up. can someone post the new recommendations?

 

[lobelsteve]

I need to take another look at the new ASRA guidelines that just came out... isn't there something for ASA 325 mg?

I thought they did some form of risk stratification...

google isn't pulling it up. can someone post the new recommendations?

http://links.lww.com/AAP/A142


These new "guidelines" are wildly divergent from ASRA. Recommends holding ASA and NSaids for SCS, pumps, kypho.
http://mobile.journals.lww.com/rapm...e=/Original.00115550-201505000-00002.TT1.jpeg

Based on these references:

2. Giberson CE, Barbosa J, Brooks ES, et al. Epidural hematomas following removal of percutaneous spinal cord stimulator trial leads: two case reports.Reg Anesth Pain Med. 2014; 39: 73–77.
Cited Here...

3. Buvanendran A, Young AC. Spinal epidural hematoma following spinal cord stimulator trial lead placement in a patient taking aspirin. Reg Anesth Pain Med. 2014; 39: 70–72.
Cited Here...

4. Ghaly RF. Recovery after high-dose methylprednisolone and delayed evacuation: a case of spinal epidural hematoma. J Neurosurg Anesthesiol. 2001; 13: 323–328.
Cited Here...

 

[hyperalgesia]

Would like to take your opinion on the following situation -
We asked for clearance from a patient's cardiologist regarding transitioning full ASA to 81 ASA prior to procedure.
Got the clearance but from his Nurse practitioner, with no countersignature from the physician himself.
Just wondering from a medicolegal standpoint:how reliable is this clearance?
Any thoughts/ advice will be greatly appreciated.

I think from a medicolegal standpoint, there is very little difference between an NP representing a cardiologist and the cardiologist.

 

[oreosandsake]

thanks Steve.

huh... I thought this was presented at the last ASRA meeting.

 

[SSdoc33]

dont hold the ASA

 

[emd123]

I don't have a problem with the NP making the decision. They have malpractice insurance just like us. Just get a signature from one of them. Fax a "anticoagulation clearance" form. Then you're good. As far as the ASA, don't forget, there's risk to stopping it. ASA is a very powerful drug in regards to stroke and MI prevention. It has a very low NNT for some of these conditions, lower that many of the hot advertised drugs. Dot think you're off the hook of a patient died of an mi or stroke after holding it for a procedure. You my have "clearance" from cards, but you'll still get sued. May win, but definitely could get sued and go to trial.

I'm good with ASRA's recommendations. Anyone have a link the the most recent ASRA updated guidelines? (Edit: yes, here- http://mobile.journals.lww.com/rapm....aspx?year=2015&issue=05000&article=00002#ath )

 

[SSdoc33]

I find it deportable that the only thing we care about is who is liable if there's a complication. What is best for the patient is secondary. Hellooooooooo tort reform.