Following LHC procedure: (example A&P)
- Acute Coronary Syndrome/NSTEMI s/p LHC with PCI and DES to OM and Diagonal Arteries.
- H/O CAD with h/o LHC and RCA stent in 2012 and residual circ disease
- Uncontrolled DM 2
- Ongoing Tobacco Abuse
- Metabolic acidosis
- Chronic low BP
- Admit to PCU
- Strict bed rest x 4 hours (only need bed rest for femoral approach, no bed rest needed for radial approach)
- Continue to monitor closely and do serial groin checks.
- Continue Integrilin x 18 hours [Integrilin: Eptifibatide = an antiplatelet drug of the glycoprotein IIb/IIIa inhibitor class, started during LHC if patient has high clot burden]
- Continue Integrilin only if started in the cath lab. Do NOT start after cath if not already on during cath.
- Continue Aspirin 81 mg PO qd indefinitely. Continue Clopidogrel 75mg Po qd for 1 year following placement of DES. Will start Clopidogrel tomorrow as he received it today during LHC.
- If does not tolerate Plavix: Will start on Effient.
- Start on Atorvastatin 40mg PO qd.
- Morphine IV PRN pain with holding parameters.
- Continue home antihypertensive medications: Lisinopril 40 mg daily and Lopressor 25 mg BID with holding parameters.
- Lantus and Accuchecks with SSI for DMII. Hold Metformin both before the LHC and 72 hours after LHC.
- EKG and Troponin prn for chest pain
- Cardiology consulted for further evaluation and follow up after LHC.
- Counselled on smoking cessation.
- CBC, CMP, Magnesium.
- Continue oxycodone for lower back pain
Code Status: Full Code
- Start prophylactic Lovenox tomorrow.
- OR: If on Integrelin drip, continue for 18 hours post-LHC. Start heparin after the Integrelin drip is over in 18 hours.
– Do not take Apixaban for 3 days following LHC. Restart after 3 days.
– Start Plavix daily. [Change Omeprazole to Protonix – less interaction with Plavix.]
– Continue taking Aspirin 81mg daily for the next month and then stop Aspirin (ex: if patient has thrombocytopenia already).
– Stop taking Naproxen and do not start taking any other NSAID medications (Ibuprofen, Aleve, etc).
– Make sure that the patient is on high-intensity statin at discharge (Atorvastatin 40-80mg PO qd).
– Follow up in Cardiology clinic in 2-3 weeks.
– No intense physical exertion for 5-7 days.
– No hot baths/ hot tubs for 5 days.
– No driving for 48 hours.
– No lifting weights more than 20 lbs for 14 days.
– If any worsening chest pain or SOB, call 911.