ANTIPLATELET THERAPY & SYSTEMIC ANTICOAGULATION

ANTICOAGULATION PEARLS

- Utilizing regional or systemic anticoagulation will be on a case-by-case basis. Systemic anticoagulation is the ideal method, but may not be possible with high-risk concomitant injuries such as traumatic brain injury, non-operative blunt solid organ injury, etc. If contraindications for systemic anticoagulation exist, regional anticoagulation is advised.
- Antiplatelet therapy with aspirin is recommended post-operatively for arterial repairs, interposition grafts (autologous or prosthetic) and bypass grafts (autologous or prosthetic) unless concomitant injuries stated above contraindicate its use.
- Systemic anticoagulation is achieved with 50 u/kg of IV heparin with 1000 u repeated at 1 hr; repeat doses are not recommended given the propensity for bleeding in wartime injury.
- “Regional anticoagulation” is the use of heparin saline flush in the inflow/outflow vessels.
- Heparin saline is typically 10000u/liter (10U Heparin/1cc of Saline), although other mixtures with or without papaverine are acceptable; there is no evidence that other ‘vein solutions’ offer any advantage.
- The use of recombinant factor VII is no longer recommended.