From the Research
Recommended Time Interval for Epidural Placement after Heparin Administration
- The recommended time interval after administering heparin (unfractionated heparin) before an epidural can be safely placed is not explicitly stated in the provided studies 1, 2, 3, 4, 5.
- However, a case report suggests that an epidural catheter was placed approximately 2 hours after a preoperative dose of 5,000 U unfractionated heparin, and the catheter was removed 6 hours after the last dose of heparin 2.
- Another study retrospectively reviewed the incidence of spinal epidural hematoma in patients receiving acute postoperative epidural analgesia and heparin 3 times per day, but does not provide specific guidance on the timing of epidural placement after heparin administration 3.
- A study on low-molecular-weight heparin (LMWH) suggests that the anticoagulant effect at the time of epidural catheter removal is more likely to be associated with a clinically important anticoagulant effect when LMWH is administered twice-daily compared to once-daily 4.
- A retrospective review of patients receiving thoracic epidural anesthesia and prophylactic three times daily unfractionated heparin within an enhanced recovery after surgery pathway for colorectal surgery found that 22.5% of patients missed one or more doses of heparin associated with epidural removal, but does not provide specific guidance on the timing of epidural placement after heparin administration 5.
Key Considerations
- The risk of thromboembolism must be weighed against the risk of hemorrhagic complications when considering the timing of epidural placement after heparin administration 1.
- Patients should be carefully assessed before, during, and after the procedure, clinically and biologically, to minimize the risk of complications 1.
- The presence of comorbid risk factors, such as spinal stenosis, may contribute to the risk of epidural hematoma 2.