Adult Critical Care Specialty (ACCS) Practice Exam

What is the recommended therapy for a patient with an INR of 1.5 and a platelet count of 150,000/mm3 prior to arterial line insertion?

1. Transfusing packed red blood cells

2. Administering Activated Factor 7

3. Infusing fresh frozen plasma

4. Maintaining current therapy of aspirin and Plavix

The correct answer is: Maintaining current therapy of aspirin and Plavix

In the context of preparing a patient for an arterial line insertion, the management of anticoagulation and hemostasis is paramount. An INR of 1.5 indicates a moderately increased risk for bleeding but may not warrant immediate intervention such as the administration of pro-coagulants or reversing agents, especially if the patient’s history and clinical presentation suggest that this level is acceptable for the planned procedure. In this scenario, maintaining the current therapy of aspirin and Plavix may be appropriate. Aspirin and Plavix are antiplatelet agents that play a significant role in preventing thrombotic events, particularly in patients with cardiovascular risk factors. Given that the platelet count is within an acceptable range at 150,000/mm³, the risk of bleeding may be manageable, and withholding these medications could increase the patient's risk for thromboembolic complications, which might outweigh the risks associated with maintaining the current regimen. In contrast, options that involve transfusing packed red blood cells, administering activated factor 7, or infusing fresh frozen plasma would be excessive and potentially unnecessary interventions. All these actions are typically reserved for more significant coagulation abnormalities or higher INR levels indicative of a greater bleeding risk. Hence, maintaining current therapy provides a balanced approach, ensuring