DMR Posted May 14, 2009 Share Posted May 14, 2009 We are seeing an increase number of patient scheduled / emergency for procedures who are on Plavix. Our providers are requesting pheresis platelets on hand for these patients from 1 to 8 or more units. Does anyone have any set protocols that they are using for these patients and their possible platelet needs when scheduled for various procedures, colonoscopy, cardiovascular, AAA, etc. Your comments are greatly appreciated.Thank you,Dmr Link to comment Share on other sites More sharing options...
L106 Posted May 14, 2009 Share Posted May 14, 2009 We are also having quite a problem with this situation. Our physicians don't seem to have any standard protocol, and even though our Hematology Dept offers "Platelet Aggregation" testing, we periodically get "surprise" STAT orders on both emergency and scheduled cases. I, too, would appreciate others' comments/protocol on this topic. Link to comment Share on other sites More sharing options...
Mabel Adams Posted May 15, 2009 Share Posted May 15, 2009 What they really need is an antidote to Plavix. Link to comment Share on other sites More sharing options...
L106 Posted May 15, 2009 Share Posted May 15, 2009 I would certainly investing in whatever company comes up with a Plavix antidote product!! Link to comment Share on other sites More sharing options...
BenchTech Posted May 16, 2009 Share Posted May 16, 2009 Our OR has used TEG testing for the last 4-5 years at our hospital to get an idea of what the total platelet inhibition in all the cases is. Over that time there was a noticeable decrease in the use of FFP, Plts and Cryo. I don't know if any of you are familiar with this testing but it's really cool. Link to comment Share on other sites More sharing options...
galvania Posted May 16, 2009 Share Posted May 16, 2009 Does anyone know whether transfused platelets actually work if a patient is on plavix? Link to comment Share on other sites More sharing options...
CUMC Posted May 16, 2009 Share Posted May 16, 2009 It doesn't seem to us that it works, because if the patient still has Plavix in their system, it seems to effect the platelets we give. I think we are treating the physician not the patient. Link to comment Share on other sites More sharing options...
Eagle Eye Posted May 18, 2009 Share Posted May 18, 2009 You need to have a test (platelet function assay) which can test for plavix inhibition effects. I believe there is a test called verify now and it tests for Aspirin effect and plavix effect. If the test is abnormal ...I will try to post the website.http://www.accumetrics.com/products/docs/Waiting_for_Clopidogrel.pdf Link to comment Share on other sites More sharing options...
Avid123 Posted May 18, 2009 Share Posted May 18, 2009 Plavix affects the platelets when they are manufactured in the bone marrow. So it should not damage transfused platelets. Link to comment Share on other sites More sharing options...
L106 Posted May 18, 2009 Share Posted May 18, 2009 Avid -Thanks for that info - it's good to know that. Can you recommend a good reference (preferably not too complicated) that my staff and I could read to learn more about how & why Plavix works?Donna Link to comment Share on other sites More sharing options...
AMcCord Posted May 18, 2009 Share Posted May 18, 2009 We occasionally give a unit or 2 of platelets to the patient post-op for hip or knee replacement, if there is oozing. The ortho surgeons used to want those plts available preop but have discovered that they rarely need them pre or post. Now they just request platelets on standby at our local blood center's satellite depot. (They are teachable!) Anesthesia, on the other hand is very nervous and they want 2 units in house. If they are doing a spinal, I don't argue with them, except to suggest we give one and keep the 2nd one at the satellite depot. That has cut our waste rate for plts quite a bit. Our surgical case load is mostly ortho, gynecological and colon resections, so we don't have nearly as much fun with this as a lot of you do. The cardiologists here are adamant that the patient does not come off Plavis preop, so I'm sure they would veto an antidote, if there was one. Our biggest nightmares are the folks who come in with a GI bleed on Plavix (and the cardiologist won't take them off it). You can suck down a lot of blood in a hurry. Link to comment Share on other sites More sharing options...
David Posted January 26, 2010 Share Posted January 26, 2010 Does anyone know of published guidelines or recommendations for amounts of platelets to give to reverse a plavix effect? We have a physician who insists on having 4-8 pheresis units available for surgery, which we find excessive and difficult. Link to comment Share on other sites More sharing options...
tbostock Posted January 26, 2010 Share Posted January 26, 2010 David, I don't have any references, but I have been trying to find info on this for a couple years. But here's some ideas:http://www.cbbsweb.org/enf/2001/pltsplavix.htmlhttp://www.cbbsweb.org/enf/1999_2000/reopro.htmlhttp://www.csmc.edu/11261.html Link to comment Share on other sites More sharing options...
Mary** Posted January 26, 2010 Share Posted January 26, 2010 How many do they use? Link to comment Share on other sites More sharing options...
L106 Posted January 26, 2010 Share Posted January 26, 2010 We encounter this situation most frequently with our open heart surgery patients. We are certain not a "respected leader" in this field, but if our cardiac surgeons give any platelets, it is usually one when they are taking the patient off the pump, and sometimes a second plateletpheresis a few hours later. (We usually don't know which patients are on Plavix.) Link to comment Share on other sites More sharing options...
Recommended Posts
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now