Monitor platelets. -Patients receiving heparin intermittent IV injection: Start oral anticoagulant 0 to 2 hours before the time the next dose of heparin … Consider discontinuing if platelets decrease by ≥ 30% from baseline and evaluate for HIT. 3. Stop warfarin 5 days pre-op. Bridge with treatment dose IV unfractionated heparin or SC enoxaparin, or low-dose SC enoxaparin. Test the ACT after heparin boluses to ensure ACT is in the target range. (2) So you’re taking care of your patient load and see an order to start a Heparin drip pop up. A PTT can be drawn just before the puncture to make sure the heparin has worn off. Heparin is a glycosaminoglycan of 12-15 kDa that binds Anti-Thrombin 3 and facilitates its ability to inhibit coagulation factors 2a (thrombin) and 10a by a factor of 1000. Heparin is a very immunogenic compound. 0.75 mg/kg i.v. Give additional heparin as required. The easiest anticoagulation to manage before and after a lumbar puncture is heparin. Bleeding is one of the most feared complications of flexible bronchoscopy. Four of the 8 patients who underwent angiography early also underwent coronary angioplasty that day; the remaining patients had bypass surgery within 24 hours (n = 2) or several days of heparin infusion for treatment of thrombus (n = 2). Not all of these antibodies cause HIT; HIT occurs in 1 to 5% of patients who receive unfractionated heparin and < 1% that receive low molecular weight heparin. Although infrequent, it can be catastrophic and result in fatal outcomes. Heparin use increases the incidence of minor bleeding (number needed to harm [NNH] = 17). 1. Please keep in mind that IV heparin is different than subcutaneous Heparin. Monitor ACT’s every 90 minutes during the procedure to maintain a target ACT of 200-230 seconds. bolus followed by 1.75 mg/kg/h during the PCI procedure and for at least 30 min but no more than 4 h afterwards. Last pre-op dose: - Stop IV heparin 4 h pre-op - 50% total dose enoxaparin 24 h pre-op When it complexes with platelet factor 4 (PF4), it induces an antibody response in up to 50% of patients. If INR > 1.5, consider vitamin K 2.5 mg PO x 1 dose. Obtain PTT 6 hours after initiation of Heparin and after any subsequent changes until therapeutic X 2, then every AM. Bridging anticoagulation refers to giving a short-acting blood thinner, usually low-molecular-weight heparin given by subcutaneous injection for 10 to 12 days around the time of the surgery/procedure, when warfarin is interrupted and its anticoagulant effect is outside a therapeutic range. This is one of those stop what you’re doing and do this as soon as possible kind of things. Download : Download high-res image (121KB) Download : Download full-size image; Fig. Compared to other endoscopic procedures, the risk of morbidity and mortality from the bleeding is increased, as even a small amount of blood can fill the tracheobronchial tree and lead to respiratory failure. Give boluses of heparin IV aiming for a target ACT of 200-230 seconds. IV unfractionated heparin is the most common anticoagulant used in the cath lab. 1. Reassess INR on day of surgery. Compared with standard therapy with aspirin, the use of heparin … Test the ACT before proceeding with the intervention 2. 4. Mechanism of action. 3. Adult Heparin Drip Protocol 2. Test INR 1-2 days prior to surgery. Heparin should be stopped 2-4 hours before the procedure. Anticoagulation should be stopped before a lumbar puncture. Heparin can be started 1 hour after an LP. How To Start a Heparin Drip. 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