Resident Net

EKG Conference Follow-up

Click (here) for slides from conference. Summary at end.

HEY, DID YOU KNOW...??

5) that the direct thrombin inhibitors affect the fibrinogen assay.

Cryoprecipitate should not be given based on a low fibrinogen activity while a patient is on a DTI.
If there is a high index of suspicion for DIC, a fibrinogen antigen should be ordered (this is not routinely done and would
have to be specified to the lab).

If there are any questions about interpreting hematologic labs, the hematology consult service is always happy to help.

4) After removing a central line, including PICCs, you must place an occlusive dressing (e.g. Tegaderm) to prevent air embolism.

3) Phenergan is preferably given by deep IM injection. If it is given IV and extravasates, gangrene can occur.

2) Common 5 drug interactions with warfarin (e.g. Coumadin, Coumarin) that require closer monitoring of INR or should be avoided. There are many drug interactions including statins and others, but these are the top 5 in commonality that cause trouble. Consider having INR check 1-2 days after discharge from the hospital especially if medication changes have been made.

sulfonamides (e.g. bactrim) -> increasing INR and bleeding risk
quinolones (e.g. cipro, moxifloxacin) -> increasing INR and bleeding risk
macrolides (e.g. Z-Pak) - > increasing INR and bleeding risk
NSAIDs - > increased risk of bleeding in general and particularly gastrointestinal bleeding
phenytoin -> both INR and phenytoin levels can be effected

1) There are many herbals taken as supplements which may effect bleeding risk and/or INR including but not limited to: