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Bleeding risk
Bleeding risk
HIGH bleeding risk
HIGH bleeding risk
INR ≤ 1.8
Plt ≥ 50,000
CBC, INR/PT routinely recommended
Anticoagulant/Antiplatelet Agent
Anticoagulants
Antiplatelets
Antibiotics
Antibiotics
No antibiotic therapy required for low risk patients
Severe Cefazolin allergy = hives or anaphylaxis to Cefazolin or DRESS/SJS/TEN to any beta-lactam
High risk patient = Cefazolin
Cefazolin IV
Adult < 120kg = 2 g
Adult ≥ 120kg = 3 g
Peds = 25 mg/kg (max = 2 g)
High risk patient with severe Cefazolin allergy = Vancomycin
Vancomycin IV
Adult < 80 kg = 1000 mg
Adult ≥ 80 kg = 1500 mg
Peds = 15 mg/kg (max = 1500 mg)
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