antiplatelet/anticoagulation lecture note

lecture by mysterious gift
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antiplatelet,e.g., aspirin, plavix, 於停藥後七到十天作用完全消失
MVR 術後, 無法 tolerate coumadin, 也可考慮用 antiplatelet
anticoagulants: aspirin 術前停用 7 天
                       plavix 術前停用 10 天
                 ticlopidine 術前停用 14 天
雙重抗血小板藥物的 indication: s/p PVI "plus" stenting
anti-thromboembolism: PCI stenting 後, 多久可 op?
                      若是 BMS, 4 weeks
                      若是 DES, 則要 6~12 months
when to re-introduce treatment in stented patients after surgery ?
    ==> restart aspirin/plavix, or BOTH, ASAP (當然 surgeon 要 confidence no bleeding)
APA in urgent surgery?
    ==> 若需緊急手術的情況, 只好輸血小板了
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anticoagulant: coumadin, 用於
                       MVR  (比 AVR 更需要吃)
                       AVR
                       A fib ( young and healthy, may be aspirin alone )
                   VTE / DVT
heparin infusion: q6h check APTT, keep 1.5~2x
LMWH/claxane: 不需抽血監測, 60mg/amp q12h
停到 INR<1.5x 可以一般手術
   神經外科手術則要等 INR<1.2x 以下才比較保險

heparin infusion 停4個小時, 效力就消失了
coumadin intake, 則須停4天, 效力才消失
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VTE prophylaxis
      claxane 60 mg/amp qd sc
      compression stocking
 risk factor: previous VTE episode
                  長期行動不便, wheel chair bound/ bed-ridden