[scubadiveRN]

I am a Neuro ICU nurse in East Texas where we have a level 1 trauma Center and a large Neuro-sciences Department.
Of course, as I am sure, American Heart Assoc's. CODE STROKE protocol is followed and TPA is used whenever possible, throughout ths country.
More and more often our patients are being sent for arteriogram and are selectively TPA'd, if a clot is found. We have a great Neuro-radiology Dept. here in East Texas and our Interventional Neuroradiologists are the Best!


As far as the Plavix - Heparin & Coumadin issue is concerend, The Great Neurologist I work with (Dr. George Plotkin MD - Harvard/Boston General) explained the use of Plavix (which is basically just an expensive Asprin Tablet) as that of when you need to stop platelet formation from happening. When you need to use heparin is where you are concerned about the second phase of clotting....ie: fibrin formation and the whole clotting cascade itself.
So, it seems that the source of / cause of the ischemia is when the decision to use Plavix and A.S.A. or Heparin and Coumadin comes into play.
Just think about it and it all makes sense....remember Plavix's action on a non living thing ( Platelet ) and how Heparin works.
So if you have small vessel ischemia or have colts from a cardiac nature (ie a clot thrown from someone in a-fib), what do you want to use?

Hope this helps out.

[ntflyer60]

I also work at a level one trauma center,only it is in Tn. If your pt. is unlucky enough to get a subdural or intercranial bleed,you can reverse heparin. With plavix I hope your hospital has ALOT of ffp hanging around or your pt won't live long enough to make it to surgery. If he does, the delay decreases the chances of a good outcome significantly. I cringe everytime I see an add for Plavix as the Drug Companies push this on consumers. I wish they could talk to some of the family members we have had to tell there was nothing more we could do for their loved one