How long before hip surgery should the heparin (Heparin Sodium) drip be stopped?

Timing of Heparin Discontinuation Before Hip Surgery

Unfractionated heparin (UFH) infusion should be stopped 4-6 hours before hip surgery to completely eliminate its anticoagulant effect. 1, 2

Unfractionated Heparin (UFH) Management

Preoperative Discontinuation

• Stop the UFH infusion 4-6 hours prior to the surgical incision to allow complete elimination of anticoagulant activity 1, 2
• UFH has a half-life of approximately 60-90 minutes, though this can vary between 30-120 minutes depending on the degree of anticoagulation at discontinuation 3, 2
• This 4-6 hour interval ensures the anticoagulant effect is fully eliminated before the procedure begins 1

Special Considerations for Neuraxial Anesthesia

• Neuraxial procedures (spinal or epidural anesthesia) are absolutely contraindicated under active anticoagulation 3, 1
• If spinal or epidural anesthesia is planned for hip surgery, ensure the UFH has been stopped for the full 4-6 hours and coagulation parameters have normalized 3
• The risk of spinal cord hematoma is a critical concern when combining anticoagulation with neuraxial techniques 3

Postoperative Resumption of Heparin

Timing of Restart

• UFH can be restarted without a bolus dose more than 4 hours after removal of the epidural catheter or surgical drain 1, 2
• For standard hip surgery with controlled hemostasis, restart UFH at ≥24 hours postoperatively using a lower-intensity infusion without bolus dosing 1
• Avoid bolus doses when restarting to minimize bleeding risk 1

Risk-Stratified Approach

• For low-bleeding risk situations: Full therapeutic-dose heparin can be restarted within 24 hours once hemostasis is confirmed 1
• For high-bleeding risk procedures (including major hip surgery): Delay full therapeutic anticoagulation for 48-72 hours postoperatively 1
• Consider intermediate-dose or prophylactic-dose heparin during the initial 48-72 hour period to balance thrombotic and bleeding risks 1

Important Clinical Pitfalls

Avoid These Common Errors

• Do not restart heparin too early postoperatively, as this significantly increases major bleeding risk—rates can reach up to 20% when bridging therapy is given too close to surgery 1
• Do not use bolus dosing when restarting UFH after major orthopedic surgery 1
• Do not perform neuraxial procedures while the patient has any residual anticoagulant effect from heparin 3, 1

Monitoring Considerations

• Point-of-care hemoglobin analyzers should be used routinely at the end of hip surgery to assess anemia and guide transfusion decisions 3
• Core temperature monitoring should be routine, as older patients undergoing hip surgery are particularly susceptible to hypothermia 3

Alternative Anticoagulants in Special Situations

If the patient has heparin-induced thrombocytopenia (HIT), different timing applies:

• Argatroban: Stop infusion 4 hours before surgery 3, 1
• Bivalirudin: Stop infusion 2 hours before surgery 3, 1
• These agents have much shorter half-lives (50 minutes and 20-30 minutes respectively) compared to UFH 3