plavix use and CABG

[heart queen]

New to a position in a CCU where all CABG's are held off for four to 5 days, unless emergent or changes occur. Rationale is that the plavix loading pre or post cath causes such an increased bleeding post op. In addition the surgeons are ordering a "platelet works" test, which measures just that, how well they function, the day prior to surgery.

Now my previous exp. was VERY cost conc. we would never keep a pt. in the hospital 4-5 days pre cabg, the insurance companies only paid for 24 hrs. pre, and that was only with elevated trops or a high risk that had a swan or IABP placed prior. (Delaying surgery required thorough explanations as to why the patient would sit having a "non reinbursed hospital day".

now I looked and plavix is out 4-5 days after the initial load... but heck, I work recovery too, and we used to CABG them even one hour post thrombolytics, one day post cath, post plavix load and post op, or intra op, any coagulopathies were treated.

Sure we had some bleeding and leaky sutures, but there were very FEW who went back to the OR with bleeding.

WHAT are you all doing? is anyone doing this "waiting to re-infarct game too?"

thanks for any info

[RNKPCE]

I heard this was the reason they held off Clinton's surgery several days.

[Dixielee, BSN, RN]

I work ER, but we give almost everyone lovenox if they are admitted with chest pain. My own sweet husband had chest pains for the first time in his life this past april. I took him to the local hospital, they gave him lovenox, shipped him to a medical center for cath in the morning. He had his cath at 0800 and was in the OR for his CABG as soon as they could get him prepped. He had no other symptoms other than the transient chest pain the day before, but he had an 87% left main occlusion. He sailed thru without complications. He had a balloon pump placed in cath lab "precautionary". They left it in till the next day to let the heparin clear his system, but he had no problems...thank God! Then they put him on plavix for 45 days post op, now off all med and doing great.

[jewelcutt]

As I'm sure you know, plavix causes a thrombocytopathia, which is a dysfunction in platelets. As one of our cv surgeons explained to me once, when you have a patient on plavix preop you have to be really careful to cauterize the sternal bleeders because if they are bleeding postop they will have to go back to the OR. A return to the OR is extremely bad for these patients. Usually holding plavix for seven days allows 50% of platelets to return to normal function, there shouldn't be a problem with re-infarction. Emergency surgeries have higher risks, including bleeding, but it has to be done to save their lives.