It's been a few years since I did my pregrad on a stroke unit. Are there any medications that are routinely given now after a CVA to help control the damage, and reduce the brain swelling?
My husband had a CVA this week, and about all they did was try to give him....ASPIRIN! (which he couldn't swallow anyway!) I mentioned coumadin (taking him off coumadin for an angiogram CAUSED the stroke in the first place!) and they said, "Oh, we don't do that because the damaged brain tissue is very delicate after a stroke, and it might bleed."
This ain't my area of nursing (obviously!) so your input would be appreciated!
Just a question: why didn't they put him on Lovenox while off the coumadin? He had to be off the coumadin at least 3 days pre-angio . . . not trying to stir up anything, it's an honest question.
Dianah,
Lovenox would have done the same thing as the Coumadin. The end result would have been the same. Lovenox is simply a low molecular weight heparin. Good question though Dianah.
Why can't by now they come up with a Lovenox pill????
I think she mentioned in the Breakroom he had to go off his coumadin for his a-fib for the angio, and then threw a clot most likely from the a-fib and not being on coumadin. That's probably why you didn't know, sorry.
I believe they are working on a pill, Tweety. And, there is no reason whatsoever that a pt. can't go home on Lovenox (in fact some do). You know the saying you can't teach an old Dr. new tricks. Some Dr's just got fixated on one Tx area and won't change because that's the way they were taught and that's what they know. The biggest setback for Lovenox is we don't really have a good way of measuring therapeutic blood levels yet.
We are still pt. advocates and there is no reason when the MD say start Heparin that we can't say "hey, what do you think about Lovenox". I've done it many times, and it's worked great for me. That way the Dr. gets to keep his dignity and big head and we get to use Lovenox. It's so much easier on us nurses and patients so much so it's ridiculous. Like I said there is no reason a patient can't continue therapy at home. It's just a simple SQ injection. Many of these patients may go home with home health care anyway. We trust diabetics are to give themselves SQ injections. What's the problem with everyone else? They just need a little nurse-patient teaching. We're in the 21st century it's time some of these old docs get there too.
I think she mentioned in the Breakroom he had to go off his coumadin for his a-fib for the angio, and then threw a clot most likely from the a-fib and not being on coumadin. That's probably why you didn't know, sorry.
I'll take a couple of deep breaths. It's okay I'll be alright. I'm just a little perplexed that I've been here this long, and no one has invited me to the breakroom yet. Sure make me eat my lunch out here all by myself.
Specializes in RETIRED Cath Lab/Cardiology/Radiology.
Dave, are you out there??? Dave, Dave, come in Dave!
Breakroom, if you're registered and after you sign in, is at the VERY bottom of the Nursing Discussion Board for Nurses screen. Scroll AAAAAAALLLLLLL the way down.
And my question was based on: when we do angios and pt is on lovenox, we just hold the a.m. dose, do the angio and then resume the p.m. dose after the angio. Then the pt is off coumadin but is still covered by the lovenox while off the coumadin. Pts with a.fib and prosthetic valves need to maintain that anticoagulated state as much as possible, to try to prevent what Jay-Jay's husband went through. Nothing is guaranteed, I know.
Dave, are you out there??? Dave, Dave, come in Dave!
Breakroom, if you're registered and after you sign in, is at the VERY bottom of the Nursing Discussion Board for Nurses screen. Scroll AAAAAAALLLLLLL the way down.
And my question was based on: when we do angios and pt is on lovenox, we just hold the a.m. dose, do the angio and then resume the p.m. dose after the angio. Then the pt is off coumadin but is still covered by the lovenox while off the coumadin. Pts with a.fib and prosthetic valves need to maintain that anticoagulated state as much as possible, to try to prevent what Jay-Jay's husband went through. Nothing is guaranteed, I know.
Carry on. :)
You have a great point there Dianah, but I can't find anything specific to Lovenox. I come up with four other low molecular heparins including Lovenox. Lovenox itself doesn't mention anything in regards to pre-op and post-op start/stop times. But, a couple of the others low molecular heparins mention that you can give them prophylaxis 1-2hrs pre-op and one other mentions 1-4hrs pre-op. That's right pre-op. Those times greatly surprise me. So your guess is as good as mine with Lovenox. Does anyone know if a Greenfield filter can be placed high enough to help prevent future strokes? Once you've had one stroke you're prone to additional clots and a-fib certainly doesn't reduce the instances. You'd think we would have come a lot farther in medicine by now. If we can perform surgery on a fetus, why can't we stop a "freakin" clot? If I can be of any further assistance to you Dianah please don't hesitate to hauler at me.
You have a great point there Dianah, but I can't find anything specific to Lovenox. I come up with four other low molecular heparins including Lovenox. Lovenox itself doesn't mention anything in regards to pre-op and post-op start/stop times. But, a couple of the others low molecular heparins mention that you can give them prophylaxis 1-2hrs pre-op and one other mentions 1-4hrs pre-op. That's right pre-op. Those times greatly surprise me. So your guess is as good as mine with Lovenox. Does anyone know if a Greenfield filter can be placed high enough to help prevent future strokes? Once you've had one stroke you're prone to additional clots and a-fib certainly doesn't reduce the instances. You'd think we would have come a lot farther in medicine by now. If we can perform surgery on a fetus, why can't we stop a "freakin" clot? If I can be of any further assistance to you Dianah please don't hesitate to hauler at me.
I thought the greenfield filter was a filter to prevent lower extremity thrombosis from traveling to the lung and causing a pulmonary embolus? There's no way to filter from the heart to the brain...is there???
Specializes in RETIRED Cath Lab/Cardiology/Radiology.
Hi Dave. I don't quite understand your question re: greefield (or IVC) filters. They're placed (in the IVC, of course!) prophylactically from the femoral vein approach, just infrarenal, to prevent any clots that may migrate from DVTs in the legs, up to the right heart and thru it to the pulmonary vasculature. Now, as to any filters that prevent strokes . . . haven't heard of any but have never done research on any cutting-edge works-in-the-works. I'm just a lowly Radiology/Cath Lab nurse, doing the grunt work, lol!
Such a device would have to be placed in each carotid artery, I'd imagine, which is not without its risks. Hey, I never thought they'd be stenting carotids but it's being done by skilled Interventional Radiologists (on a select group of patients, I'm sure) with the assistance of wonderful technology: there are guide wires that extend past the stent that have an umbrella-type device that corrals any clots and prevents them flowing to the brain while the stent is deployed. I've never attended one of those cases although I'd love to. The time may come!
Re: the lovenox question. I'm just relating our Cardiologist's practice, I have no studies to which to refer.
Thanks for the exchange. Did you find the Break Room???
Just a question: why didn't they put him on Lovenox while off the coumadin? He had to be off the coumadin at least 3 days pre-angio . . . not trying to stir up anything, it's an honest question.
I've asked myself the same thing many times in the last few days! I've had many patients on low molecular wt. heparin before different types of surgery/procedures. The drug of choice in Ontario seems to be Fragmin, though I have seen Lovenox being used too. Maybe they figured the A-fib was enough under control that it wasn't necessary. It will certainly be my first question for his cardiologist the next time I get to talk to her!!
Hi Dave. I don't quite understand your question re: greefield (or IVC) filters. They're placed (in the IVC, of course!) prophylactically from the femoral vein approach, just infrarenal, to prevent any clots that may migrate from DVTs in the legs, up to the right heart and thru it to the pulmonary vasculature. Now, as to any filters that prevent strokes . . . haven't heard of any but have never done research on any cutting-edge works-in-the-works. I'm just a lowly Radiology/Cath Lab nurse, doing the grunt work, lol!
Such a device would have to be placed in each carotid artery, I'd imagine, which is not without its risks. Hey, I never thought they'd be stenting carotids but it's being done by skilled Interventional Radiologists (on a select group of patients, I'm sure) with the assistance of wonderful technology: there are guide wires that extend past the stent that have an umbrella-type device that corrals any clots and prevents them flowing to the brain while the stent is deployed. I've never attended one of those cases although I'd love to. The time may come!
Re: the lovenox question. I'm just relating our Cardiologist's practice, I have no studies to which to refer.
Thanks for the exchange. Did you find the Break Room???
Originally posted by southern rn
I thought the greenfield filter was a filter to prevent lower extremity thrombosis from traveling to the lung and causing a pulmonary embolus? There's no way to filter from the heart to the brain...is there???
Your right southern rn the Greenfield is generally placed in the IVC for pulmonary emboli.
Southern rn & dianah, I'm simple speaking hypothetically when it comes to a carotid filter. But, what if and why not? Of course you couldn't use a Greenfield because they're simply way to big I would think. I also understand there would be a reasonable risk. There has to be something we could use. If we can guide wire, clean them up and stent the carotids. Then why on earth can't we place a filter there? I'm just thinking out loud. This is the 21st century. Dianah you know nursing I have'nt had a chance for a break yet.
Specializes in RETIRED Cath Lab/Cardiology/Radiology.
Dave -- I agree, and was just "speculating" with ya! Why must we send probes to Mars, when there's so much potential for advancement HERE? Just my 2 cents.
Dave -- I agree, and was just "speculating" with ya! Why must we send probes to Mars, when there's so much potential for advancement HERE? Just my 2 cents.
It's not even the fact that were exploring Mars. It's the several trillion dollars to do it that's the problem. Seems to me that would feed a whole bunch of people and cure as many with disease.
NeuroICURN
377 Posts
Best wishes to both you and your hubby!
:kiss