Most patients can take oral medications and clear liquids while they are on bed rest. Elevation of the head to 15° or reverse Trendelenburg helps reduce chance of aspiration and improves comfort. Narcotics, acetaminophen, antihistamine, antiemetics, aspirin, clopidogrel, beta-blockers, angiotensin-converting inhibitors, or calcium channel blockers for preexisting hypertension are often prescribed. Unfractionated heparin is turned off prior to sheath removal. Hydration with normal saline and oral fluids are encouraged to reduce potential acute tubular necrosis and subsequent renal insufficiency from contrast administration.
Other renal protective strategies include premedication with acetylcysteine and bicarbonate drips but are not generally used now based on research showing lack of efficacy. High dose (80 mg) atorvastatin is given to buffer the kidneys if it is tolerated by the patient. Rarely, vasopressors such as nitroglycerin or norepinephrine may be needed. Coronary vasospasm, re-occlusion of a vessel, or severe bleeding necessitate emergent recatheterization or transfer to the operating room or intensive care unit.