How long should one wait following placement of an epidural catheter to restart thromboprophylaxis with enoxaparin?
It is recommended that enoxaparin be used with extreme caution if at all in patients with indwelling epidural catheters. If a careful risk/benefit analysis of epidural catheterization favors the use of continuous epidural analgesia during treatment with LMWH, at least 2 hours should pass after placing an epidural catheter or subarachnoid block before restarting enoxaparin. Usually the dose is delayed until 10-12 hours postoperatively to avoid hemorrhagic complications associated with the sugical procedure2, 7, 10.
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.