Reopro on Step-down unit

When I worked in the step-down cardiac unit (ratio 1:4), we often had patients post interventional cath on Reopro. As you are well aware (I am sure), Reopro is the most potent of the antiplatelet agents and the only reversal is to infuse platelets. (In other words, monitor very closely for bleeding!) But in answer to your question, with our decent nurse-patient ratios on our unit, we had no difficulty effectively and safely monitoring these patients. I don't think this would be very safe, however, on a "step-down" with 6 or 8 patients per nurse!!!

Anyone out there use Aggrastat? My hospital seems to be the only one around that uses it...

Anyone out there use Aggrastat? My hospital seems to be the only one around that uses it...

We used Aggrastat all of the time in the step down cardiac unit in which I used to work. We also frequently used Integrilin (eptifibatide), and, of course, Reopro. It really depends on the cardiologist's preference as to which GP IIb-IIIa inhibitor. My former employer is a tertiary care center and considered one of the top 50 hospitals for cardiovascular diseases and heart surgery in the nation.

We use reopro occasionally for our post intervention cath patients. Most of the time we use integrillin. We have a 5:1 or 6:1 ratio on nights. We do the frequent vitals and observation with pts on reopro as we do with our pts who have not had an intervention. Of course if pt is bleeding from site and on any of the above drugs they will recieve closer monitoring.

Anyone out there use Aggrastat? My hospital seems to be the only one around that uses it...

A trial come out a few years ago that aggrasstat did very poorly in. After that it pretty much has gone by the waist side. And I've seen reopro do some amazing things in the cathlab. And I've been in labs that still just use Heparin only.

A trial come out a few years ago that aggrasstat did very poorly in. After that it pretty much has gone by the waist side. And I've seen reopro do some amazing things in the cathlab. And I've been in labs that still just use Heparin only.

Traveler,

Yes because of the study I was asking if anyone else still uses Aggrastat. One more reason to leave this hospital and head back to civilization.

Have not used Aggrastat for at least 4 years, mostly based on the the studys.

Bwick, a few years ago we changed the policy regarding Reopro from all pts to ICU to may go to Tele with ration 1:4 or 5 but only after the 2 hr platlet count is back and reviewed and the goin site has adequate hemostasis. Any drop in platlet count requires the patient to stay in the post procedure unit (1:2 or 3), the 4 hour platlet count taken and reviewed. Any patients with significant drop must go to AMCU (stepdown 1:3) or ICU. Recently though the doc's tend to give more Integrilin or Angiomax.

Have not used Aggrastat for at least 4 years, mostly based on the the studys.

Thanks for the info about Aggrastat - wasn't aware of the research.

This is interesting. I haven't worked on that floor in a couple of years, but the med-surg floor with tele capabilities had patients on reopro, with at least a 6 patient per nurse ratio, maybe more.

Our stepdown unit takes both reopro and integrillin both pre and post procedure. Patient ratio varies from 4-6. We have had no problems.

We are considering transferring patients after interventional procedures with Reopro to the step down unit. They occasionally get post interventional procedures but not with Reopro. Most interventional patients go to the ICU (combined ICU). RN ratio is 3:1 or 4:1 on step-down. What are other hospitals doing? What is your ratio? Thanks

We are considering transferring patients after interventional procedures with Reopro to the step down unit. They occasionally get post interventional procedures but not with Reopro. Most interventional patients go to the ICU (combined ICU). RN ratio is 3:1 or 4:1 on step-down. What are other hospitals doing? What is your ratio? Thanks

I have worked on a step-down unit for the last 2 yrs and we take all post-interventions w/out complications (rarely do we send post caths/intervention patients to ICU). My unit can initiate and maintain heparin gtts and we maintain reopro/integrillin/aggrestat gtts. Over the past year the MDs have become more selective in which patients they order these gtt's on instead of placing almost every intervention pt on a gtt. Our ratios for days can range but usually 4-5:1 and nights 5-6:1

I personally had a pt w/reopro started in cardiac recovery post intervention whose 2hr plt count was 15,000 and the recheck was 12,000. The gtt was stopped and the pt was moved to the floor. The 4hr plt count was 4,000 and the 1hr count was 1,000 (scary right!) This patient ended up getting 12 units of plts and stayed 3-4 more days in the hospital (then our pt's normally do) because it took his plt count forever to come back up and stay.

Why do the interventions go to the unit? I can't imagine....We are a small hospital (58 beds total) and only have 12 unit beds. We do AT LEAST 30 interventional cases a day. The really sick ones go to the unit but 99% go to tele.

We use Integrillin, Reopro and Aggrastat depending on the doctor. Our ratios are 4-6:1 on both days and nights.