Lovenox Discontinuation Before CABG Surgery
Discontinue enoxaparin (Lovenox) 12 to 24 hours before CABG surgery and transition to unfractionated heparin per institutional practice. 1
Timing of Discontinuation
- Stop enoxaparin 12-24 hours prior to elective CABG and dose with unfractionated heparin (UFH) according to your institution's protocol 1
- This recommendation comes from ACC/AHA guidelines specifically addressing patients with unstable angina/NSTEMI who require CABG, but applies broadly to CABG patients on enoxaparin 1
- The 12-24 hour window allows adequate clearance of enoxaparin's anticoagulant effect while maintaining anticoagulation coverage through UFH 1
Transition to Unfractionated Heparin
- Continue UFH perioperatively rather than leaving patients without anticoagulation during the enoxaparin washout period 1
- UFH is preferred over enoxaparin in the immediate perioperative period because it has a shorter half-life and can be more easily reversed if needed 1
- This bridging strategy maintains thrombotic protection while optimizing surgical hemostasis 1
Comparison with Other Anticoagulants
For context on timing of other anticoagulants before CABG:
- Fondaparinux: discontinue 24 hours before CABG and bridge with UFH 1
- Bivalirudin: discontinue 3 hours before CABG and bridge with UFH 1
- Unfractionated heparin: can be continued perioperatively 1
Critical Pitfalls to Avoid
- Do not continue enoxaparin up to the time of surgery - the longer half-life compared to UFH increases bleeding risk during CABG 1
- Do not leave patients without anticoagulation during the washout period - transition to UFH maintains protection against thrombotic events in high-risk ACS patients 1
- Do not confuse enoxaparin timing with antiplatelet timing - while clopidogrel requires 5-7 days discontinuation and aspirin is typically continued, enoxaparin only needs 12-24 hours 1