I am not a cardiac nurse but isn't ASA supposed to be DCd

Noney · Mar 9, 2004

Actually we give asa precath. It is part of our standing orders. You want to decrease the likeliness of forming/throwing a clot during the procedure. We do hold lovenox and heparin day of cath. We give plavix precath for ptca's.

Noney

neneRN, BSN, RN · Mar 9, 2004

We give ASA pre cath as well (unless pt is on coumadin). In addition to this, we ALSO give 300 mg Plavix and 5000 Units Heparin IVP.

CHIRN · Mar 9, 2004

Our docs use Integrilin (another anticoagulant) during almost every procedure. The risk for thrombosis outweighs the risk for bleeding at the insertion site post-cath. In fact Intergrilin continues to run for six hours post-procedure. And yes, we give ASA and Plavix pre-procedure at our hospital too. Seems to work great.

Hope this eases your mind a bit.

MargRN, BSN · Mar 9, 2004

Yes this eases my mind greatly!

I SO appreciate your help and taking time to post.

PMHNP10 · Mar 9, 2004

I am not a cardiac nurse but isn't ASA supposed to be DCd prior to a cardiac catheterization?
I hate not being "up" on cardiac information. I remember in nursing school (grad with BSN in '95) that the main thing we watched for was after the procedure at the groin site for bleeding. ASA seems like it should be stopped but the cardiologist's nurse said to continue taking it as normal.
Thanks for any help or links.

I'm not a cardiac nurse either, but I think as previously mentioned the ASA is continued in order to prevent any clots from being formed. I understand your logic, thinking that they are tapping an artery and you don't want it to bleed forever, but that is why the s/p cath pt. goes to a stepdown unit or recovery area and lies down for like 8 hrs flat on their back with a sandbag on their groin to make sure the thinned blood and punctured artery doesn't end up becoming a major bleed.

Stlcardsrock · May 3, 2004

ASA use pre-cath depends on the physician and the facility.

I would be more worried about bleeding post-cath with IIb/IIIa inhibitors like Reopro, or even with Lovenox. Good hemostasis post-cath with either a fem-stop or Syvek patch can prevent groin site bleeding. Use of a closure device like Angio-seal can let patients get up almost immediately post-procedure.

If you want more info on the specifics of ASA and Plavix, please visit this site, it's a powerpoint presentation.

http://www.crtonline.org/documents/Cannon_Controversies_in_Antiplatelet_Rx_-_WHC_2002.ppt

Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.

--Voltaire

oicu8bacilli · Aug 19, 2004

Same here. If going to our cath lab you are getting ASA. Some folks like to give a bunch of Plavix pre procedure too. Naturally, all of our interventions are coming out on Integrillin or Reopro (hopefully integrillin) and we too use Syvek for a lot of cases.

All NSAIDs are typically held prior to CABG, but not cath.

RNKPCE · Aug 19, 2004

Aspirin is not stopped. If the patient is suspect of coronary artery disease they need the thinning effects to assure no clots form and catch in clogged arteries. I think years ago it was stopped but not any more. Some of my patients come back on integrillin, plavix, enoxaparin, and aspirin. I think this is why there closure devices leak as often as they do.

oicu8bacilli · Aug 19, 2004

Yes. Lovenox was my other point (and heparin). What sense does stopping ASA make when AMI folks get Lovenox in the ED, then go to the Cath Lab and get 5,000 or 7,000 of heparin, then get on Integrillin (or some other 2b3a), then get ASA and Plavix when alert and able to swallow.

That darn Lovenox is why folks leak so badly when you get them out of the cath lab. We fought that every day where I worked. If you know they are going to the lab, save the Lovenox and start Integrillin instead.

BTW, anyone else having completely unreliable ACT drops after Angiomax?

oicu8bacilli · Aug 19, 2004

He's also on Toprol XL 200 mg QD, HCTZ (I need to check dosing), Lipitor, and just started Vasotec 2.5mg.

I just noticed...that is ALOT (as in ALOT!!) of toprol. It's basically a long acting beta blocker (same as lopressor/metoprolol, but long acting) I've had pt's on every form of BP drug...beta blocker...ACE...CCCB...nitrates....and monoxidil at the same time .....with no results....but never seen anyone with 200 of toprol. Interesting that they stick with HCTZ instead of going to a loop drug and a nitrate. I've also bolused folks with IV nitrates and had no response in pressure....so anything is possible in humans.

donnaharris · Oct 4, 2004

I am not a cardiac nurse but isn't ASA supposed to be DCd prior to a cardiac catheterization?
My family member is 72 years old and taking ASA 325mg. He's also on Toprol XL 200 mg QD, HCTZ (I need to check dosing), Lipitor, and just started Vasotec 2.5mg.
I hate not being "up" on cardiac information. I remember in nursing school (grad with BSN in '95) that the main thing we watched for was after the procedure at the groin site for bleeding. ASA seems like it should be stopped but the cardiologist's nurse said to continue taking it as normal.
I am seeing red flags but not sure what to do. The cath is scheduled for next week.
Thanks for any help or links.

I've worked in CICU/CCU for 6 years. It is our protocol to ALWAYS give ASA and Plavix prior to Cardiac Caths. This will prevent clots developing in the coronarys during the cath procedure which could lead to a MI.