Author:
Johan Malmgren
Updated:
14 August, 2024
This section describes the recommended discontinuation times for various anticoagulants before surgery and 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) | Substance | Recommended time from intake of pharmaceuticals to spinal anaesthesia/manipulation | Recommended 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) |
Arixtra | Fondaparinux | 36 hours | 6 hours |
Xarelto | Rivaroxaban | 2 days according to SSTHS Clinical Council | 6-24 hours (according to risk) |
Waran, Coumadin, Jantoven ** | Warfarin | 1-4 days depending on dose | Reinsert after removal of epidural catheter |
Aspirin, Acetylsalicylic acid Aggrenox, Alka-seltzer, and more | Acetylsalicylic 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 more | Diclofenac | 12 hours | Should be avoided – COX-2 inhibitors are recommended instead |
Toradol, Acular, Acuvail, Omidria, and more | Ketorolac | 24 hours | Should be avoided – COX-2 inhibitors are recommended instead |
Naproxen, Aleve, Naprelan, Naprosyn, and more | Naproxen | 48 hours | Should be avoided – COX-2 inhibitors are recommended instead |
Plavix, Duoplavin, Zyllt | Clopidogrel | 5 days | After catheter removal |
Ticlide | Ticlopidine | 5 days | After catheter removal |
Effient, Efient | Prasurgrel | 7 days according to. SSTHS Clinical Council | After catheter removal |
Eliquis | Apixaban | 2 days according to. SSTHS Clinical Council | 6-24 hours (according to risk) |
Pradaxa | Dabigatran | 2 days according to. SSTHS Clinical Council | 6-24 hours (according to risk) |
Brilinta, Brilique | Tiacagrelor | 5 days | 6 hours |

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