ASRA Guidelines Flashcards
What do the ASRA guidelines say about NSAID use prior to neuraxial anesthesia?
No contraindication to RA with concurrent NSAID use.
What do the ASRA guidelines say about plavix use prior to neuraxial anesthesia?
Discontinued 7 days prior to neuraxial anesthesia.
What do the ASRA guidelines say about Ticlid (ticlopidine) use prior to neuraxial anesthesia?
Discontinue 14 days prior
Mechanism and class of ticlopidine and clopidegrel?
ADP-receptor inhibition and belong to the thienopyridine class
What do the ASRA guidelines say about glycoprotein IIB/IIIa inhibitor use prior to neuraxial anesthesia?
Discontinue 8 - 48 hours prior depending on half life of the specific medication.
Name three glycoprotein IIB/IIIa inhibitors.
Abciximab
Tirofiban
Eptifibatide
These are antiplatelet medications
When are glycoprotein IIb/IIIa inhibitors typically used?
During interventional cardiology procedures.
What do the ASRA guidelines say about subcutaneous heparin use prior to neuraxial anesthesia?
There is no contraindication to neuraxial anesthesia for subq heparin in twice daily dosing where total daily dose is > 10,000 units. More than this dose–>safety has not been established. Consider delay if the block is anticipated to be difficult.
What do the ASRA guidelines say about IV heparin use and neuraxial anesthesia?
Wait at least an hour post-block to administer IV heparin. Wait 2 - 4 hours since last dose before pulling a catheter.
What do the ASRA guidelines say about low-molecular weight heparin use and neuraxial anesthesia?
Twice daily dosing = wait 24 hours Single daily (prophylactic) dosing = wait 10 - 12 hours Wait 4 hours after placement of neuraxial anesthesia (with or without catheter) before administering another dose or pulling a catheter.
What do the ASRA guidelines say about herbal supplements like garlic and neuraxial anesthesia?
No discontinuation recommended.
What do the ASRA guidelines say about coumadin use and neuraxial anesthesia?
Wait for normalization of the INR before placing a catheter/performing spinal. If coumadin is started after epidural catheter placement, INR must be < 1.5 for catheter to be pulled.
What class of drug is coumadin?
Vitamin K antagonist
What are the vitamin k derived factors?
II, VII, IX, X, protein C, protein S
What is fondaparinux?
A Factor Xa inhibitor like enoxaparin.
What is the mechanism of enoxaparin?
Factor Xa inhibition
How do the ASRA guidelines for fondaparinux differ from those of enoxaparin?
Fondaparinux may place the patient at greater risk for neuraxial bleeding. Thus, if fondaparinux is to be initiated after neuraxial anesthesia, it should be only in the case of a single, uncomplicated spinal injection. Difficult placement or catheterization should preclude its use. Avoid catheters.
What do the ASRA guidelines say about fondaparinux use prior to neuraxial anesthesia.
Nothing. However, the European Guidelines recommend waiting 36 - 42 hours after the last dose.
What drugs act by direct thrombin inhibition?
Argatroban Dabigatran (a.k.a. pradaxa) Bivalirudin Desirudin Lepirudin
Hirudins are derived from where and are what class of drug?
Leeches
Anticoagulants via direct thrombin inhibition
What do the ASRA guidelines say about direct thrombin inhibitor use and neuraxial anesthesia?
They state there is insufficient evidence and thus recommend avoidance of regional techniques.
What class of drug is alteplase and how does it work?
Thrombolytic via plasminogen activation
Name three plasminogen activators.
Alteplase
Reteplase
Tenectplase
What do the ASRA guidelines say about plasminogen activors and neuraxial anesthesia?
Their use is an absolute contraindication to neuraxial anesthesia.
