Cough Management in Post-Tracheostomy Patients on Antiplatelet Therapy

Introduction to Cough Management

Post-tracheostomy cough is common and requires careful management, especially in patients with cardiovascular disease on antiplatelet therapy, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
Coughing in tracheostomy patients is considered an aerosol-generating procedure that requires special attention to minimize complications, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 1, 3

The American College of Cardiology recommends that patients on dual antiplatelet therapy (aspirin and ticagrelor) following PTCA should continue this standard care to prevent thrombotic events 4, 5
The American College of Cardiology and the American Society of Anesthesiologists advise that ticagrelor should not be discontinued as patients with coronary stents require continued antiplatelet therapy to prevent stent thrombosis 6, 7
For patients with a history of percutaneous coronary intervention, the American College of Cardiology and the American Diabetes Association recommend maintaining dual antiplatelet therapy to prevent major adverse cardiovascular events 5, 7

The American Academy of Otolaryngology-Head and Neck Surgery recommends avoiding medications with sedative properties that could compromise respiratory function in a patient with tracheostomy 1
The American Academy of Otolaryngology-Head and Neck Surgery advises avoiding saline instillation before suctioning as it increases risk of coughing and provides little benefit while potentially increasing aerosolization 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends using closed-circuit suctioning with an inline suction catheter to manage secretions and minimize aerosolization risk 2, 3
The American Academy of Otolaryngology-Head and Neck Surgery suggests ensuring proper humidification using Heat Moisture Exchanger (HME) with viral filter rather than nebulized humidification to reduce coughing and secretion buildup 2, 8
The American Academy of Otolaryngology-Head and Neck Surgery recommends maintaining proper cuff inflation (20-30 cmH2O for air-filled cuffs) to ensure integrity of the ventilation system while preventing tracheal injury 2