Neuraxial Anesthesia And Anticoagulation

Neuraxial Anesthesia and anticoagulation • IV heparin e.g. vascular Sx → delay IV heparin 1hr post catheter placement, and catheter removal 2-4 hr after the last dose or one hr before the next dose • S.C heparin also delay catheter placement 2-4 hrs, or delay the heparin 1 hr post catheter placement • LMWH: needle placement 10-12hrs after the last dose of LMWH, if Pt receiving a higher dose 1mg/kg → delay 24hr • Post-op 1st dose of LMWH delay 24 hr, and may keep the catheter until next AM, give LMWH 2hrs later • Anti-PLT: plavix→ ?? no data, but better at least 10 days before needle placement, NSAID are OK • Pt on oral med (Warfarin) → stop 5 days per-op INR= 1.4 is OK