Please check with an anaesthetist before giving first dose of dalteparin as regional
anaesthesia may have been planned.

Drug eGFR ml/min When to stop to permit spinal or epidural anaesthesia
Warfarin n/a
  • INR should be equal to 1.4
  • Full anticoagulation is an absolute contra-indication to spinal or epidural block
Unfractionated heparin n/a Allow 4 hours between previous dose and insertion of block or removal of catheter. Delay 1st dose for 2 hours after instituting a block
Low molecular weight heparin (prophylactic dose) n/a Allow 12 hours between previous dose and insertion of block or removal of catheter
Low molecular weight heparin (therapeutic dose) n/a Allow 24 hours between previous dose and insertion of block or removal of catheter
Aspirin n/a Proceed as normal
Clopidogrel n/a 7 days, last dose day - 8
Apixaban 1,3
  • CrCl greater than 30
  • CrCl less than 30
  • 48h, last dose day - 3
  • 72h, last dose day - 4
Dabigatran 2,3
  • CrCl greater than/equal to 50
  • CrCl 30 - 49
  • 48h, last dose day - 3
  • 96h, last dose day - 5
Rivaroxaban 1,3
  • CrCl greater than 30
  • CrCl less than 30
  • 48h, last dose day - 3
  • 72h, last dose day - 4
Edoxaban 1,3
  • CrCl greater than 30
  • CrCl less than 30
  • 48h, last dose day - 3
  • 72h, last dose day – 4

 

1: Direct factor Xa inhibitor

2: Direct thrombin inhibitor

3: with these drugs conventional tests of coagulation may be normal despite full therapeutic anticoagulation