How long should one wait following a dose of enoxaparin for thromboprophylaxis to remove an epidural catheter?
Removal of an epidural catheter may potentially dislodge clot within the epidural space. In 15 of 32 cases of spinal hematomas reported by Vandermeulen where an epidural catheter was used, spinal bleeding occured immediately after the removal of the epidural catheter10. A period of 10-12 hours after the last dose of enoxaparin is recommended before removing a catheter2, 7, 10.
Unfortunately there is little data regarding the continued use of low molecular weight heparin while an epidural catheter is in place. Although it appears to be safe, an increased risk may be associated with catheter movement in the epidural space during flexion or extension of the spine which may traumatize veins or preexisting clot.
REFERENCES
2. Horlocker-TT, Heit-JA. Low molecular weight heparin: biochemistry, pharmacology, perioperative prophylaxis regimens, and guidelines for reginoal anesthestic management [review]. Anesth Analg 1997;85:874-85.
7. Hynson-J-M, Katz-J-A, Ulrich Bueff-H. Epidural hematoma associated with enoxaparin [case report]. Anesth Analg 1996; 82:1072-5.
10. Vandermeulen-EP, Aken HV, Vermylen-J. Anticoagulants and Spinal-Epidural Anesthesia [Review]. Anesth Analg 1994;79:1165-77.