The following comments apply when a prophylactic dose of LMWH is being given. If the patient is on a therapeutic dose of LMWH, contact the Anaesthetist for advice.
If spinal/epidural is a possible mode of anaesthesia, then LMWH is required to be given at least 12 hours or more BEFORE procedure is to take place (e.g., 5.00 pm administration day before surgery would be suitable).
Any subsequent dose is given at least 6 - 8 hours AFTER the procedure.
If unable to administer LMWH 12 hours or more before the procedure, e.g., day of surgery admission, then omit pre-op LMWH unless it is certain that spinal/epidural will not be administered. The Anaesthetist will administer the LMWH or give instructions as to when LMWH may be given.
When removing the epidural catheter, ensure that no LMWH has been given in the previous 12-16 hours. Once catheter is removed, any subsequent dose of LMWH should not be given for 6-8 hours. If any concerns contact the Duty Anaesthetist (pager 8120).
Dabigatran/rivaroxaban
Dabigatran should not be started until at least 6 hours AFTER the procedure.
Rivaroxaban: discuss with Anaesthetist (or Duty Anaesthetist pager 8120) if it is to be started within 24 hours of procedure.