How long should Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) be held prior to a PainTeq LinQ procedure?

NSAIDs Discontinuation Before PainTeq LinQ Procedure

NSAIDs should be discontinued at least 3 days before a PainTeq LinQ procedure to minimize bleeding risk while balancing thrombotic risk. 1

Rationale for NSAID Discontinuation

• Epidural and spine interventional procedures are considered moderate to high-risk interventions that require appropriate management of antiplatelet and anticoagulant medications 1
• NSAIDs inhibit platelet function and can increase the risk of bleeding during interventional procedures 2
• The feared complications of NSAIDs in spine procedures include platelet dysfunction and perioperative bleeding 2

Specific Timing Recommendations by NSAID Type

Different NSAIDs require different discontinuation periods based on their pharmacokinetics:

• Short-acting NSAIDs (1 day discontinuation):

  • Diclofenac (Voltaren)
  • Ibuprofen (Advil, Motrin)
  • Ketorolac (Toradol) 3

• Intermediate-acting NSAIDs (2-4 days discontinuation):

  • Etodolac (Lodine) - 2 days
  • Indomethacin (Indocin) - 2 days
  • Meloxicam (Mobic) - 4 days
  • Naproxen (Aleve, Naprosyn) - 4 days
  • Nabumetone (Relafen) - 4 days 3

• Long-acting NSAIDs (6-10 days discontinuation):

  • Oxaprozin (Daypro) - 6 days
  • Piroxicam (Feldene) - 10 days 3

Special Considerations

• For patients on low-dose aspirin for secondary cardiovascular or cerebrovascular prevention, consider continuing aspirin through the perioperative period and consulting with cardiology 2
• COX-2 selective inhibitors (celecoxib) provide anti-inflammatory effects with less bleeding risk than traditional NSAIDs but should still be discontinued before moderate to high-risk procedures 2
• The risk of thromboembolic events must be balanced against the risk of bleeding complications when deciding whether to discontinue NSAIDs 4

Risk Stratification

• Risk factors that increase bleeding potential during interventional procedures:

  • Anatomic pathology (spinal stenosis, ankylosing spondylitis)
  • Multiple needle attempts during the procedure
  • Concurrent use of other anticoagulants
  • Renal impairment 4, 5

• For patients at high risk of thromboembolic events who require NSAID discontinuation:

  • Consider cardiology consultation for management recommendations 2
  • If thromboembolic risk is high, NSAIDs can be resumed 12 hours after the procedure if hemostasis is adequate 4

Common Pitfalls to Avoid

• Failing to recognize that epidural procedures are moderate to high-risk interventions requiring appropriate medication management 1
• Continuing NSAIDs in combination with anticoagulants, which significantly increases bleeding risk 2, 1
• Not accounting for the specific type of NSAID when determining discontinuation timing 3
• Traumatic needle placement during the procedure increases bleeding risk, especially if antiplatelet medications haven't been properly discontinued 1

Following these guidelines will help minimize bleeding complications while maintaining patient safety during the PainTeq LinQ procedure.