aggrastat and heparin at the same time?

[wrkoutgirl]

hi all. do you have experience on trating pts with aggrastat and heparin at the same time? is it only at ccu and in very special cases where pt needs extensive anticoagulation? please tell me as much as you can about this. i thought one or the other was the safe thing to do. my drug book says that they are not reccomended together b/c of risk of bleeding. now if you do infuse both, do you need a separate line? thank you. monica

[mattsmom81]

Rarely I see pts with coagulopathies who are high risk for emboli treated with several of these drugs together. Some inhibit platelets, some prolong clotting times and other aspects of the clotting mechanism. These patients who are are at high risk for bleeding as well as clotting need precautions and close monitoring of coags in critical care settings for sure.

Aggrastat and Reopro are usually used post invasive PTCA AND in ACS/AMI in my ICU. The Heparin/Lovenox will sometimes be added for DVT history. We always give Reopro and Aggrastat in a dedicated line by itself and monitor hematology, platelets, and symptoms closely.

[wrkoutgirl]

Rarely I see pts with coagulopathies who are high risk for emboli treated with several of these drugs together. Some inhibit platelets, some prolong clotting times and other aspects of the clotting mechanism. These patients who are are at high risk for bleeding as well as clotting need precautions and close monitoring of coags in critical care settings for sure.

Aggrastat and Reopro are usually used post invasive PTCA AND in ACS/AMI in my ICU. The Heparin/Lovenox will sometimes be added for DVT history. We always give Reopro and Aggrastat in a dedicated line by itself and monitor hematology, platelets, and symptoms closely.

thank you Matt. i want to invest on amor actualized drug book what do you reccomend?

[zambezi, BSN, RN]

We occassionally use both together in the CCU that I work in, especially if we get a patient that has had unstable angina and are not going to be cathed until the morning for whatever reason. For our heparin monitoring we do ptts Q6 hrs until therapeutic then QD. For aggrastat we do CBC two hours after initiation then QD and check platelets (or more often if necessary...)

[1OldDinosaurRN]

hi, just happened on this. what about in rural hospital er's? in prep for transfer to cath lab at larger hosp 2* to acute mi? i think we've sent them out having had both.

i also incidentially have a beef :angryfire about lovenox, anyone else agree? my poor patients are black and blue and sometimes with hematomas on their abds due to this. i mean, just because they're elderly and on bedrest initially and in for pneumonia--do we have to go this route? i hate the subq injections of heparin and lovenox. anyone else whose docs have a better way of handling prevention for dvt?

[Dinith88]

Our IIb/IIIa of choice is integriilin. We'll use heparin and integrillin together in coronary patient's who need extensive anticoagulation.

Heparin and IIb/IIIa's(aggrastat, reopro, integrllin) affect coagulation in different ways. If you see heparin gtt's and IIb/IIIa's together, the heparin is probably not for DVT history, but rather to help 'cool down' platelets in an ACS. These 2 drug classes work great together, but these pt's need to be in CCU/ICU to be monitored closley...not only because of their ACS/MI, but also because they're at a much greater risk of bleeding(obviously).

We'll use heparin gtt's ALOT more frequently than lovenox when used in conjunction w/IIb/IIIa's because the elevated ptt's can be reversed quicker (for sheath pulls, bleeding complications,etc.), whereas lovenox takes ~12 hrs.

[wrkoutgirl]

thank you all. i learned new stuff. from all of you. happy valentine's day. monica :rotfl: