enoxaparin therapy should be delayed for: • 12 hours after spinal puncture or epidural catheter placement • 4 hours after epidural catheter removal • 12 hours after C-Section If more than one of these scenarios applies to a particular patient, follow the longest wait period before restarting enoxaparin.
High Alert Drug: Low molecular weight heparin
• Nurses and pharmacists verify dose and that patient is not on another anticoagulant prior to administration. • Two RNs independently verify dose prior to administration if the dosing requires manipulation (i.e. drawing up a portion of a vial, or giving a portion of a syringe}. • Anticoagulation comparison chart available on nursing units for reference. • Pharmacists/nurses provide patient education for oral anticoagulants. • Pharmacists monitor for appropriate dosing, labs, and prevention of adverse events. • Lovenox located in separate drawer from heparin in dispensing cabinet
Anticoagulant / Antiplatelet Stoppage For Procedures
generic (Brand)
Dept.
Procedure Type (hover over entry for examples)
Stop Medication Prior To Procedure Restart after:
enoxaparin (Lovenox) prophylactic
Anesthesia
High-risk
12 hours Restart after 12-24 hours
Intermediate-risk
12 hours Restart after 12-24 hours
Low-risk
12 hours Restart after 4 hours
Patients with high risk of bleeding (eg, old age, history of bleeding tendency, concurrent uses of other anticoagulants/antiplatelets, liver cirrhosis or advanced liver disease, and advanced renal disease) undergoing low- or intermediate-risk procedures should be treated as intermediate or high risk, respectively.
Radiology
Invasive Procedures
3 days
Paracentesis/Thoracentesis
12 hours
Surgery
High-risk
24 hours Restart after 48-72 hours
Low-risk
24 hours Restart after 24 hours
enoxaparin (Lovenox) therapeutic
Anesthesia
High-risk
24 hours Restart after 12-24 hours
Intermediate-risk
24 hours Restart after 12-24 hours
Low-risk
24 hours Restart after 4 hours
Patients with high risk of bleeding (eg, old age, history of bleeding tendency, concurrent uses of other anticoagulants/antiplatelets, liver cirrhosis or advanced liver disease, and advanced renal disease) undergoing low- or intermediate-risk procedures should be treated as intermediate or high risk, respectively.
• 12 hours after spinal puncture or epidural catheter placement
• 4 hours after epidural catheter removal
• 12 hours after C-Section
If more than one of these scenarios applies to a particular patient, follow the longest wait period before restarting enoxaparin.
• Two RNs independently verify dose prior to administration if the dosing requires manipulation (i.e. drawing up a portion of a vial, or giving a portion of a syringe}.
• Anticoagulation comparison chart available on nursing units for reference.
• Pharmacists/nurses provide patient education for oral anticoagulants.
• Pharmacists monitor for appropriate dosing, labs, and prevention of adverse events.
• Lovenox located in separate drawer from heparin in dispensing cabinet
(hover over entry for examples)
(Lovenox)
prophylactic
(Lovenox)
therapeutic