Protected: Alcohol Withdrawal Detoxification Order Sheet (Sample)

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Treatment of Elevated BP in Acute Ischemic Stroke

 

BP treatment in AIS

Sample Stroke Order Sets

TIA Order Set:

Ischemic Stroke Order Set:

Another Ischemic Stroke Order Set:

ICH Order Set:

Protected: Nimodipine

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How to switch from Coumadin to DOACs and vice versa

VKA to DOAC (upper panel)

  • If INR 2.0-2.5, DOAC can be started immediately of the next day.
  • If INR >2.5, actual INR value and half-life of VKA need to taken account to estimate when INR will drop into the range, then schedule a repeat INR at that time.

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DOAC to VKA

  • measure INR before next intake of DOAC during concomitant administration
  • retest 24h after last dose of DOAC
  • monitor INR closely within 1st month until stable values attained

 

Reference:

Heidbuchel, H., Verhamme, P., Alings, M., Antz, M., Diener, H., Hacke, W., Oldgren, J., Sinnaeve, P., Camm, A. and Kirchhof, P. (2016). Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary. European Heart Journal, p.ehw058.

Perioperative Management of DOACs

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Bold values deviate from the common stopping rule of ≥24 h low risk, ≥48 h high risk. Low risk: with a low frequency of bleeding and/or minor impact of a bleeding; high risk with a high frequency of bleeding and/or important clinical impact.

(a)Many of these patients may be on the lower dose of dabigatran (i.e. 110 mg BID) or apixaban (i.e. 2.5 mg BID), or have to be on the lower dose of rivaroxaban (i.e. 15 mg OD) or edoxaban (i.e. 30 mg OD).

 

Reference:

Heidbuchel, H., Verhamme, P., Alings, M., Antz, M., Diener, H., Hacke, W., Oldgren, J., Sinnaeve, P., Camm, A. and Kirchhof, P. (2016). Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary. European Heart Journal, p.ehw058.

Anticoagulation After Stroke

European Heart Association Guideline recommends:

  • 1 days after TIA
  • 3 days after mild stroke
  • 6 days after moderate stroke
  • 12 days after severe stroke

 

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No strong evidence for this algorithm.

Another study showed that clinicians continue anticoagulation in most patients with acute stroke who use anticoagulation at amission except for those with severe neurological deficits (NIHSS >15).  Continuation of anticoagulation was not associated with a higher risk of bleeding.

 

 

References:

Groot, A., Vermeij, J., Westendorp, W., Nederkoorn, P., van de Beek, D. and Coutinho, J. (2018). Continuation or Discontinuation of Anticoagulation in the Early Phase After Acute Ischemic Stroke. Stroke, pp.STROKEAHA.118.021514.

Heidbuchel, H., Verhamme, P., Alings, M., Antz, M., Diener, H., Hacke, W., Oldgren, J., Sinnaeve, P., Camm, A. and Kirchhof, P. (2016). Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary. European Heart Journal, p.ehw058.