How many hours should Heparin (hep) drip be stopped before surgery?

From the Guidelines

Heparin infusion (drip) should be stopped at least 4 hours before surgery. This recommendation is based on the most recent and highest quality study, which suggests stopping IV UFH 4 hours before a surgery/procedure over stopping IV UFH < 4 hours before a surgery/procedure 1. For standard unfractionated heparin, stopping the infusion 4 hours prior to surgery is usually sufficient as its half-life is approximately 60-90 minutes. This allows time for the anticoagulant effect to wear off, reducing the risk of excessive bleeding during the procedure.

• The exact timing may vary based on the patient's kidney function, as heparin is primarily cleared by the kidneys, and the specific surgical procedure being performed.
• For high-risk bleeding procedures, surgeons may request a longer discontinuation period.
• Before proceeding with surgery, the medical team will often check coagulation parameters such as activated partial thromboplastin time (aPTT) to ensure the anticoagulant effect has adequately diminished.
• If emergency surgery is needed while a patient is on heparin, protamine sulfate can be administered to reverse the anticoagulant effects. The American College of Chest Physicians clinical practice guideline supports this recommendation, suggesting that stopping UFH 4 hours before a surgery/procedure is the preferred approach 1.

From the Research

Heparin Drip Management Before Surgery

The management of heparin drip before surgery is crucial to prevent bleeding complications. The following points summarize the key findings:

• The duration for which heparin drip needs to be stopped before surgery is not explicitly stated in the provided studies. However, the management of anticoagulation therapy, including heparin, is discussed in the context of perioperative care 2, 3.
• A study on the perioperative management of patients taking direct oral anticoagulants (DOACs) suggests that the risk of procedure-related bleeding should be classified as minimal, low to moderate, or high to determine the management strategy 3.
• For patients undergoing surgery, the management of heparin and protamine is critical to prevent bleeding complications. A tailored approach to heparin and protamine management can improve thromboelastometric parameters and postoperative hemostasis in valve surgery 4.
• The use of protamine to reverse heparin anticoagulation varies among surgeons, and adverse reactions to protamine can occur, including hypotension, pulmonary artery hypertension, anaphylaxis, and death 5.

Key Considerations

• The management of heparin drip before surgery should be individualized based on the patient's risk factors and the type of surgery being performed.
• The use of protamine to reverse heparin anticoagulation should be carefully considered, and the patient should be monitored for adverse reactions.
• The classification of the risk of procedure-related bleeding can help determine the management strategy for patients taking anticoagulation therapy, including heparin 3.

Heparin Drip Stoppage

• There is no specific recommendation on the exact number of hours heparin drip needs to be stopped before surgery in the provided studies. However, the management of anticoagulation therapy, including heparin, is crucial in the perioperative period to prevent bleeding complications 2, 3.