Supplemental Online Lesson

Lesson S08: PreAnesthetic Assessment of the Patient on Low Dose Aspirin and a Thienopyridine – PART 2

Registration Fee: $15.00
2.0 AMA PRA Category 1 Credits^TM

Release Date: September 1st, 2009
 Termination Date:  September 30th, 2010

Click on the link below to download and print the course material and post-test exam.  Register for the exam to enter your responses to receive CME credit.  There are ten questions in the examination and you must achieve a score of 80% or better to earn CME credit.  Following successful completion, your certificate will be immediately available online.  In addition, a historical record of  completed CME courses is maintained online in an individualized profile.  This includes copies of course certificates which can be printed at any time.

The registration fee for this course is $15.00

Physicians are provided with two opportunities to successfully complete the exam presented here. 

Software Requirements: Adobe Acrobat Reader and any standard Internet Browser.

Combination therapy with low dose aspirin and a thienopyridine, such as clopidogrel (Plavix®), is commonly prescribed for patients with risk factors for myocardial infarction, cerebrovascular accident and embolic phenomenon. Because of the widespread use, physicians are more frequently confronted with patients who require surgery while receiving dual antiplatelet therapy. Concerns include excessive bleeding in patients requiring emergent surgical care, or the development of hematoma in patients receiving regional block. Fatal myocardial infarction has recently been described following the discontinuation of clopidogrel in patients with drug eluting stents (i.e. stents coated with medication that is slowly released to prevent the growth of scar tissue in the artery lining). Physicians should be knowledgeable of the medical evidence so that they may properly advise surgical candidates receiving antiplatelet medications as to the risks and timing of surgery and the impact of anesthetic techniques.

A 73 year old woman with a long standing history of osteoporosis was examined in the holding area of the operating room. A total knee replacement was scheduled that day. She had a past history of hypertension and coronary artery disease. She was morbidly obese and wore a Med Alert® bracelet indicating that she had a difficult airway. A note from her cardiologist reported that she had a drug eluting stent placed 3 months prior and she had been advised to take clopidogrel 75mg and aspirin 81mg daily. She stated that she stopped the clopidogrel for the past 5 days as recommended by her orthopedist.

LEARNING OBJECTIVES

At the end of this activity, the participant should be able to:

1. Describe a preoperative workup for a patient with suspected coagulopathy.

2. Note the specific laboratory testing for patient with coagulopathy.

3. Discuss drug interactions with herbal preparations.

4. List findings of a physical exam that are indicative of potential problems.

5. Evaluate the limitations of test for bleeding time.

6. Explain preoperative considerations for patients on low dose aspirin.

7. Understand the recommendations for patients who have had a drug eluting stent placed.

8. Draw up an anesthetic plan for a patient on dual antiplatelet therapy.

9. Discuss considerations for discontinuing anticoagulant therapy preoperatively.

10. Understand the perioperative complications that may occur in a patient on aspirin therapy.

TARGET AUDIENCE:  Anesthesiologists

Accreditation Statement

Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: The Mount Sinai School of Medicine designates each educational activity for a maximum of 2 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is the policy of Mount Sinai School of Medicine to ensure objectivity, balance, independence, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices.

Disclosures

The author, reviewer, and editor have no relationships with pharmaceutical companies or manufacturers of products to disclose. This educational activity may contain discussion of published and/or investigational uses of agents for the treatment of disease. Some uses of these agents have not been approved by the FDA. Please refer to the official prescribing information for each product for approved indications, contraindications, and warnings.

CONTACT INFORMATION

Questions regarding course content may be directed to Dr. Elizabeth Frost: ElzFrost@aol.com.

If you require technical assistance with completing this course, please contact Continuing Education Online Customer Service at 718-648-8080 or send e-mail to ceo.contact7@proceo.com.

CALL FOR WRITERS

If you would like to write a CME lesson in Anesthesiology News, please send an e-mail to Elizabeth A.M. Frost, MD, at ElzFrost@aol.com