ASRA GUIDELINES FOR ANTICOAGULATION 2010 PDF

ASRA last published guidelines regarding anticoagulation in see reference below. What follows is summary of these guidelines. New guidelines will be published in Thrombolytics: There is insufficient data to support specific recommendations regarding a safe time period for neuraxial puncture to take place after receiving thrombolytics. If patient has indwelling catheter, ASRA recommends neurologic checks at least every 2 hours and limiting the infusion to drugs that minimize sensory and motor block grade 1C. There are no recommendations regarding safe timing for removal of a catheter that has been in place after receiving thrombolytics.

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ASRA last published guidelines regarding anticoagulation in see reference below. What follows is summary of these guidelines. New guidelines will be published in Thrombolytics: There is insufficient data to support specific recommendations regarding a safe time period for neuraxial puncture to take place after receiving thrombolytics.

If patient has indwelling catheter, ASRA recommends neurologic checks at least every 2 hours and limiting the infusion to drugs that minimize sensory and motor block grade 1C. There are no recommendations regarding safe timing for removal of a catheter that has been in place after receiving thrombolytics. However, it is recommended that a fibrinogen level be checked prior to removal as this is one of the last clotting factors to recover grade 2C.

The next dose of SQH can be given 1 hour after catheter removal. Wait hours after the last dose of LMWH prior to removing catheter. The next dose of LMWH can be given 2 hours after catheter removal.

Neurologic exams should continue for 24 hours after catheter removal grade 2C. If the INR is 1. ASRA recommends against neuraxial techniques grade 2C.

Recent study of patients reported no hemorrhagic concerns. Catheters in this study were removed 36 hours after the last dose of fondaparinux and the next was held for 12 hours post-catheter removal. Definition ASRA last published guidelines regarding anticoagulation in see reference below.

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Advisories & guidelines

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ASRA guidelines – Epid cath removal

The actual incidence of neurologic dysfunction resulting from hemorrhagic complications associated with neuraxial blockade is unknown. Although the incidence cited in the literature is estimated to be less than 1 in , epidural and less than 1 in , spinal anesthetics, recent epidemiologic surveys suggest that the frequency is increasing and may be as high as 1 in in some patient populations. Overall, the risk of clinically significant bleeding increase with age,associated abnormalities of the spinal cord or vertebral column, the presence of an underlying coagulopathy, difficulty during needle placement,and an indwelling neuraxial catheter during sustained anticoagulation particularly with standard heparin or low-molecular weight heparin. The need for prompt diagnosis and intervention to optimize neurologic outcome is also consistently reported. Practice guidelines or recommendations summarize evidence-based reviews. However, the rarity of spinal hematoma defies a prospective randomized study, and there is no current laboratory model. As a result,the ASRA consensus statements represent the collective experience of recognized experts in the field of neuraxial anesthesia and anticoagulation.

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Evolving standards for the prevention of perioperative venous thromboembolism VTE and the introduction of increasingly potent antithrombotic medications have resulted in concerns regarding the heightened risk of neuraxial bleeding. Furthermore, societies and organizations seeking to address these concerns through guidelines in perioperative management have issued conflicting recommendations. Earlier guidelines did not specify a time interval between SC administration of UFH and neuraxial blockade. These recommendations are based on the pharmacology of SC U dose of UFH, which results in a significant anticoagulant effect that persists 4 to 6 hours after administration.

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