Exam 1: How Long to Hold Anticoagulants + Coagulation Notes

Question 1

Holding ASA:
*High Risk
*Low Risk/Neuraxial

Answer 1

*High Risk: 4-6 days

*Low Risk/Neuraxial: NO NEED TO HOLD

Question 2

Holding NSAIDS:
*High Risk
*Intermediate Risk
*Low Risk/Neuraxial

Answer 2

*High Risk: 5 Half-Lives

*Intermediate Risk: Consider holding for Cervical ESI and Stellate Ganglion Block

*Low Risk/Neuraxial: Defer to Policy

Question 3

Holding Glycoprotein 2b/3a Antagonists:
*Tirofiban + Eptifibatide
*Abciximab

Answer 3

*Tirofiban + Eptifibatide: 4-8 hours

*Abciximab: 24-48 hours

Question 4

Holding Thienopyridine Derivatives:
*Clopidogrel
*Prasugrel
*Ticlopidine (Ticlid)

Answer 4

*Clopidogrel: 5-7 days

*Prasugrel: 7-10 days

*Ticlopidine (Ticlid): 10 days

Question 5

Holding Unfractionated Heparin/LMWH

Answer 5

24 hours

Question 6

Holding Warfarin

Answer 6

5 days + INR < 1.5

Question 7

Hold Thrombolytics

Answer 7

ALWAYS HOLD, as ABSOLUTE CI TO NEURAXIAL ANESTHESIA

Question 8

Holding DOAGs:
*Apixiban (Eliquis)

Answer 8

72 hours

Question 9

Hold Herbals:

Answer 9

Proceed as normal; no need to hold

Question 10

Normal aPTT

Answer 10

25-32 sec

Question 11

Normal PT

Answer 11

12-14 sec

Question 12

Normal INR

Answer 12

0.8-1.1

Question 13

Extrinsic Pathway
*Labs
*Factors
*Meds

Answer 13

*INR, PT, Bleeding Time
*3,7
*Coumadin,Warfarin

Question 14

Intrinsic Pathway
*Labs
*Factors
*Meds

Answer 14

*PTT
*8,9,11,12
*Heparin

Question 15

Common Pathway
*Factors

Answer 15

*1,2,5,10,13

Question 16

Normal Bleeding Time

Answer 16

3-7 minutes

Question 17

Normal PLT

Answer 17

150-300k

Question 18

Neuraxial Absolute CI:
*Coagulopathy Values

Answer 18

*INR>1.5
*PLT<100k
*Coag disorder taking anticoags
*PT/aPTT/Bleeding Time x2 normal values