Q: 74 year old male is admitted to ICU with fever, dehydration, headache (specific complaint of tenderness of the scalp to touch), history of weight loss and transient visual loss. Patient also has a history of atrial fibrillation. Astute ICU attending started steroids to cover giant cell arteritis. Surgical team is consulted for temporal artery biopsy. Which of the following medications should be stopped in preparation for temporal artery biopsy?
A) Lopressor
B) Aspirin
C) Warfarin
D) Cardizem CD
E) none of the above
Answer: E
Temporal artery biopsy is a superficial dermatologic procedure done under local anesthesia. Warfarin may increase the risk of bleeding slightly but the risk of adverse events from stopping regular medications far outweigh the small risk of bleeding associated with the biopsy. Using local anesthetic with epinephrine reduces the risk of small vessel oozing. In case of further bleeding, other superficial measures can be applied like direct pressure, sutures, electrocautery, or topical hemostatic agents.
A) Lopressor
B) Aspirin
C) Warfarin
D) Cardizem CD
E) none of the above
Answer: E
Temporal artery biopsy is a superficial dermatologic procedure done under local anesthesia. Warfarin may increase the risk of bleeding slightly but the risk of adverse events from stopping regular medications far outweigh the small risk of bleeding associated with the biopsy. Using local anesthetic with epinephrine reduces the risk of small vessel oozing. In case of further bleeding, other superficial measures can be applied like direct pressure, sutures, electrocautery, or topical hemostatic agents.
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