general
- No procedures if:
- INR > 1.5
- Hgb < 7
- platelets: spontaneous bleeding @ 20-30
- PLT lifespan: 7 days
- Don’t transfuse usually if there is an underlying consumptive process
- for surgery- transfuse right before to get max effect
agents
Warfarin
- Vit K antagonist
- THERAPEUTIC: INR 2.0-3.0
- Coag Factors: 10, 9, 7, 2
- Reversal agents:
- Vit K
- FFP (will not reverse INR to less than 1.5)
- 4-factor
Heparin/LMHW
- Heparin: Anti-thrombin III and Anti-Xa activity
- LMHW: Anti-Xa
- IV / SQ
- THERAPEUTIC: titrate aPTT to 60-80s or Anti-Xa level
- Reversal agents
- Protamine sulfate
- FFP (will not reverse INR to less than 1.5)
- 4-factor
Fondaparinux:
NSTEMI
DOACs
- outpatient
- Pre-op: hold for 3 days
- More evidence showing efficacy every year but system is more comfortable with older agents
- Reversal: andexanet alfa
unique situations
Patients with PTC (percutaneous transhepatic cholangiogram catheter)
- No cholesterol entering GI tract
- Impaired fat digestion
- decreased fat-soluble vitamin absorption (ADEK)
- impairs coagulation factor synthesis
- give “Aqua-dek” (water soluble ADEK)