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Discontinuation times of anticoagulation before spinal anesthesia – guidelines and safety

The Anesthesia Guide » Topics » Discontinuation times of anticoagulation before spinal anesthesia – guidelines and safety

Author:
Johan Malmgren



Updated:
26 August, 2025

This section describes the recommended discontinuation times (stop time) for various anticoagulants before spinal anesthesia. It outlines appropriate discontinuation times for both the insertion and removal of spinal catheters.

Discontinuation times of anticoagulation before neuraxial anesthesia

Discontinuation of Anticoagulation Before Spinal Anesthesia

Medication (Brand name)SubstanceRecommended time from intake of pharmaceuticals to spinal anaesthesia/manipulationRecommended time from spinal anaesthesia/manipulation to intake of medication
Fragmin ≤ 5000 E
Fragmin > 5000 E
Dalteparin
10 hours
24 hours
6 hours recommended (2-4 hours usual practice)
ArixtraFondaparinux 36 hours6 hours
XareltoRivaroxaban2 days according to SSTHS Clinical Council6-24 hours (according to risk)
Waran, Coumadin, Jantoven **Warfarin 1-4 days depending on doseReinsert after removal of epidural catheter
Aspirin, Acetylsalicylic acid Aggrenox, Alka-seltzer, and moreAcetylsalicylic acid 12 hours in patients with secondary prevention indication
3 days with others
Resume as soon as possible after surgery
Voltaren, Aleve Arthritis Pain, Arthrotec, and moreDiclofenac 12 hoursShould be avoided – COX-2 inhibitors are recommended instead
Toradol, Acular, Acuvail, Omidria, and moreKetorolac24 hoursShould be avoided – COX-2 inhibitors are recommended instead
Naproxen, Aleve, Naprelan, Naprosyn, and moreNaproxen 48 hoursShould be avoided – COX-2 inhibitors are recommended instead
Plavix, Duoplavin, ZylltClopidogrel 5 daysAfter catheter removal
TiclideTiclopidine 5 daysAfter catheter removal
Effient, EfientPrasurgrel 7 days according to. SSTHS Clinical CouncilAfter catheter removal
EliquisApixaban2 days according to. SSTHS Clinical Council6-24 hours (according to risk)
PradaxaDabigatran 2 days according to. SSTHS Clinical Council6-24 hours (according to risk)
Brilinta, BriliqueTiacagrelor 5 days6 hours
When can you place an epidural in relation to anticoagulant treatment?

Link to Recommendations for discontinuing anticoagulants before neuraxial blockade, epidural, and spinal. Click here! 

 




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The content on AnesthGuide.com is intended for use by medical professionals as an educational and clinical information resource and is based on practices and guidelines within the Swedish healthcare context. While all articles are reviewed by experienced professionals, the information provided may not be error-free or universally applicable.
Users are advised to always apply their professional judgment and consult relevant local guidelines.

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