Angiomax: Use and Dosing Regimen

Featured

Tags

angiomax

Space 1

Editor’s Note:

The use of alternatives to heparin in terms of managing anicoagulation doesn’t come up often.  So many of us get a bit rusty when it comes to using exotic agents such as Ancrod (Hirudin), Angiomax and similar agents.

So here is a brief refresher, and as always- a disclaimer here:  Use this information with due prejudice, and verify through your own research and due diligence prior to implementing.

Space 1

Angiomax Perfusion Considerations

  • Reconstitute Angiomax in OR- 250 mg in powder with 5 cc NSS=  50 mg per ml.
  • No heparin coated surfaces (circuit, CDI, Swann Ganz- etc)
  • Angiomax ½ life = 25 minutes
  • Will precipitate if blood is allowed to pool
  • Observed clot in the pericardium (after Angiomax is bolused)  is Normal- remove with cell saver suction- Not pump suckers!
  • Angiomax is excreted via kidneys- Diurese postoperatively to get ACT back to baseline.
  • Vancomycin may inhibit function of Angiomax.  Uses dedicated infusion pump to avoid contact with vancomycin.

 

Dosing

  • Target ACT is 500 seconds
  • 1 mg per kg for initial dose (off pump)
  • Maintenance Dose:  1.75 mg/kg/hr (increase in 0.15 to 0.45 mg/kg/hr  increments)

 

Perfusion Circuit:

Prime: Normal  Add 50 mg Angiomax

Cardioplegia-  Prefer Crystalloid only (if using blood- always recirculate Cardioplegia to Avoid Stasis!

Arterial Venous Bridge at field to recirculate after CPB

Remove CDI (Heparin issue)

Use Hemoconcentrator Only when rewarming- remove 300 cc and test act.

Continue with that algorithm- not allowing ACT to fall below 300 on CPB.

 

Other Considerations

Cooling Potentiates Action of Angiomax- and Warming accelerates excretion.

Rewarming and maintaining core temp at 37 Celsius is key- for Angiomax reversal!

Put 50 mg Angiomax in Pump after coming off bypass.

Space 1

Experienced Perfusionist: Seeking Locums Work in South and Midwest

Featured

Tags

,

Cowboy Pic for Locums

Certified Clinical Perfusionist very experienced

Knowledgeable and experienced with most surgical procedures but not limited to:

  • Adult Cardiopulmonary Bypass,
  • Valves,
  • Complex Arches
  • Minimally invasive,
  • ECMO,
  • IABP,
  • Monitoring,
  • Autotranfusion,
  • Platelet gel,
  • VADS

Contact this person privately at ecclog@gmail.com

Kindest Regards

Professional Details

  • Experience in all aspects of perfusion
  • Bachelors Degree
  • Licensures: Texas, ArkansasABCP, BLS and CPR, Current TB.

Professional and Personal Strengths:

  • Hard worker
  • Team Player
  • Positive Attitude, integrity
  • Professional and Conscientious
  • Follows through with assignments
  • Ability to work independently of others in an elective, urgent, or emergent capacity
  • Excellent Communication Skills
  • Excellent Computer / Internet Skills
  • Very Proficient with the STS National Database
  • Excellent References

Perfusion Art: “The Stanley Cup!”

Tags

,

Stanley Cup

“The Stanley Cup! ___ __Click image to enlarge-Space 1

Photographer:  Unknown

EquipmentDigital:

EditingBy ‘Surfers:

Narrative:  I saw this picture on FB but forgot to note the photographer (plz contact me so I can credit you):  Anyway- For some reason, it just reminded me of the Stanley Cup Hockey trophy- so that’s where the name comes from.

Time & Place 2015 FaceBook

Space 1