Bleeding is one of the most feared complications of flexible bronchoscopy. Give boluses of heparin IV aiming for a target ACT of 200-230 seconds. Stop warfarin 5 days pre-op. Heparin should be stopped 2-4 hours before the procedure. 1. Bridge with treatment dose IV unfractionated heparin or SC enoxaparin, or low-dose SC enoxaparin. How To Start a Heparin Drip. Download : Download high-res image (121KB) Download : Download full-size image; Fig. Test the ACT before proceeding with the intervention 2. Obtain PTT 6 hours after initiation of Heparin and after any subsequent changes until therapeutic X 2, then every AM. Monitor platelets. (2) 1. 1. 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. Please keep in mind that IV heparin is different than subcutaneous Heparin. A PTT can be drawn just before the puncture to make sure the heparin has worn off. -Patients receiving heparin intermittent IV injection: Start oral anticoagulant 0 to 2 hours before the time the next dose of heparin … Reassess INR on day of surgery. The major adverse effect of heparin is heparin-induced thrombocytopenia (HIT), a paradox in which an anticoagulant causes a severe procoagulant condition due to antibodies directed against the complex of heparin and platelet factor 4, a protein constituent of alpha granules and platelets that is released following platelet activation. 3. So you’re taking care of your patient load and see an order to start a Heparin drip pop up. The easiest anticoagulation to manage before and after a lumbar puncture is heparin. Heparin is a very immunogenic compound. IV Heparin is Different Than Subcutaneous Heparin. Anticoagulation should be stopped before a lumbar puncture. Following this mandatory infusion, a reduced-dose infusion (0.2 mg/kg/h) for up to 20 h could be administered at physician discretion 8.8% bivalirudin vs. 13.2% heparin, vs. 17% for heparin plus tirofiban, P < 0.001 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). Give additional heparin as required. -Patients receiving heparin continuous IV infusion: Stop heparin immediately after administering the first dose of oral anticoagulant. Compared with standard therapy with aspirin, the use of heparin … 3. 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. Heparin can be started 1 hour after an LP. 4. 0.75 mg/kg i.v. Adult Heparin Drip Protocol 2. If INR > 1.5, consider vitamin K 2.5 mg PO x 1 dose. IV unfractionated heparin is the most common anticoagulant used in the cath lab. Consider discontinuing if platelets decrease by ≥ 30% from baseline and evaluate for HIT. 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. Monitor ACT’s every 90 minutes during the procedure to maintain a target ACT of 200-230 seconds. Test INR 1-2 days prior to surgery. Although infrequent, it can be catastrophic and result in fatal outcomes. Mechanism of action. Heparin use increases the incidence of minor bleeding (number needed to harm [NNH] = 17). Last pre-op dose: - Stop IV heparin 4 h pre-op - 50% total dose enoxaparin 24 h pre-op Heparin Antibodies . When it complexes with platelet factor 4 (PF4), it induces an antibody response in up to 50% of patients. 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