Plavix vs Lovenox before surgery

[mrsamruso]

Hello!

I work in HomeCare and I am trying to figure something out. I have a patient who is currently on Plavix and Aspirin daily. He is having surgery on 10/24 and his MD said he would have to hold both prior to surgery. He has AFib and a pacemaker. My question is, would this patient be taken off those two and out on Lovenox, or just taken off Plavix and Aspirin with nothing added? I don't understand how they wouldn't have to be on something when my Coumadin/Warfarin patients go on Lovenox. Help!!

The more info the better, I am trying to really understand the background with this!

Thanks in advance!

[MunoRN, RN]

It generally takes some time for a clot to form in A-fib off of anticoagulation, so as a general rule it's considered safe for patient who are on coumadin for A-fib to come off of all anticoagulation just long enough to have a surgery or procedure done.

From UpToDate: "The authors concluded that perioperative anticoagulation may be unnecessary for a significant proportion of low to intermediate risk outpatients who have undergone long-term anticoagulation, whose warfarin therapy must be interrupted for a brief period (ie, ≤5 days), and that bridging therapy with unfractionated or LMW heparin may result in significant and potentially avoidable perioperative hemorrhage."

[AgentBeast, BSN, RN]

Did the patient recently (within the last year or two) have a stent placed? Typically those are the patient's you'll see on Plavix and it's buddy ASA not afibbers.