Download Antiplatelet medications

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

Document related concepts

Harm reduction wikipedia , lookup

Special needs dentistry wikipedia , lookup

Electronic prescribing wikipedia , lookup

Adherence (medicine) wikipedia , lookup

Intravenous therapy wikipedia , lookup

Pharmacogenomics wikipedia , lookup

Transcript
Antiplatelets, Anticoagulants
What are the consequences
Dr Jeremy Wright
Cardiologist
Hearts1st, Greenslopes Private Hospital
Outline

2 clinical cases

Overview of haemostasis

Antiplatelet medications

Anticoagulant medications

Strategy for peri-procedural management
Case 1




86yo female
RCA stent 6 months ago
Hb 55, large colorectal cancer
Transfusion, staged anterior resection

Pre-op phone assessment advised stop Aspirin and
Clopidogrel 1 week prior to surgery

Anterior resection performed

In recovery - chest pain and intermittent bradycardia
Case 1



Multiple VF arrests
Aspirated
Intubated

Angio showed stent thrombosis
IV heparin, eptifibatide

Prolonged stay in ICU

Discharged home 1 month later

Case 2

83 yo female
2 days post stent to LAD
Aspirin and Clopidogrel
Pleural effusion
Pleural tap requested to exclude empyema

Large haemothorax

Deceased despite resuscitation




Haemostasis
Haemostasis
Antiplatelets
Anticoagulants
Antiplatelet medications

Aspirin
- Cartia, Astrix, etc

Clopidogrel
- Plavix, Iscover

Prasugrel
- Effient

Ticagrelor
- Brilinta

Fish Oil, Chinese Herbs

GP IIb/IIIa inhibitors – Reopro, Aggrastat
Coronary Artery Stents

Three ‘Generations’
1.) Bare Metal (BMS)
2.) Drug Eluting (DES) (first generation)
3.) Drug Eluting (DES) (second generation)

BMS require dual antiplatelet therapy for at least 1 month

DES require dual antiplatelet therapy for at least 6 months

Aspirin must continue
Anticoagulants

Older agents
- Oral: Warfarin
- Injection: Heparin, Clexane, Danaparoid, Fondaparinux

New oral agents
- Dabigatran (Pradaxa)
- Rivaroxaban (Xarelto)
- Apixaban (Eliquis)

New injection agents
- Lepirudin (Refludan)
- Bivalirudin (Angiomax)
- Desirudin (Revasc)
Time required for medications to wear off

Antiplatelets: 7 days

Warfarin: 5 days

Injections: 6-24 hours

New oral agents
- Dabigatran (Pradaxa) 2 days if eGFR>50, otherwise 5 days
- Rivaroxaban (Xarelto) 1-2 days
- Apixaban (Eliquis) 1-2 days
General Principles

Assess thromboembolic risk of stopping medication
- Why taking the medication
- How long ?
- Previous bleeding problems

Assess bleeding risk associated with the procedure

Ultimate responsibility lies with the Dr performing the
procedure, assisted by the referring Dr

Bridging medications may be required in some circumstances
Confused?

CSANZ 2009

Warfarin for prosthetic valves ?
Confused?

Society of Interventional Radiology Consensus Guidelines

J Vasc Interv Radiol 2009; 20:S240-S249
Take home messages

Critical to find out what the patient is taking – oral, SC, IV

There are many new medications
- If not sure, look it up or ask

These decisions can be complex

Communication is the key