dr_jojo
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I wanna know what is the CI to heparin and Lytics use in diffrent setting plz (post operative / history of ischemic stroke , fracture ,.........
( in case of ISCHEMIC stroke and then develop PE , in this situation
if he is UNstable we should give thrombolytics ..........
if he is stable .........heparin
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| Aashi
Forum Moderator
Topics: 114
Posts: 1,062
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Hemodynamically Unstable P.E---->indication for thrombolytics, unless the pt has C.I to its use..if C.I do embolectomy
If recent stroke/ hx of IC hemmorhage( any time)---->and now P.E-->best answer is IV filter--->this is also indicated if pts goes into recurrent P.E when on anticoagulants..
CONTRAINDICATIONS to tPA
1. Rapidly improving or minor symptoms
2. Evidence of intracranial hemorrhage on pretreatment exam
3. History of intracranial hemorrhage
4. Suspicion of subarachnoid hemorrhage
5. Recent intracranial surgery or serious head trauma or recent previous stroke (<3 months)
6. Major surgery or serious trauma excluding head trauma in the previous 14 days
7. On repeated measurements, systolic blood pressure is >185 mmHg or diastolic blood pressure is >110 mmHg at the time treatment is to begin, and patients require aggressive treatment to reduce blood pressure to within these limits
8. Seizure at onset of stroke
9. Active internal bleeding
10. History of gastrointestinal or urinary tract hemorrhage within 21 days
11. Recent arterial puncture at a noncompressible site
12. Recent lumbar puncture
13. Intracranial neoplasm, arteriovenous malformation, or aneurysm
14. Known bleeding diathesis, including, but not limited to:
15. Current use of oral anticoagulants (e.g., warfarin sodium) or recent use with international normalized ratio (INR) >1.2
16. Administration of Heparin within 48 hours preceding the onset of the stroke or an elevated activated Partial Thromboplastin Time (aPTT) at presentation
17. Platelet count <100,000 mm3
18. Abnormal blood glucose (<50 or >400mg/dL)
19. Post myocardial infarction pericarditis
20. Age less than 18 years old.
GL
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
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| dr_jojo
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Thanx Aashi ,
for PE ,if the pt stable , and we should give heparin but has recent history of ischemic stroke
,what is the CI for heparin in general and in case of PE ,
is it the same CI to lytics
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