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ASRA Guidelines

The ASRA guidelines provide recommendations for managing neuraxial anesthesia in patients on thromboprophylaxis, detailing the timing for discontinuation and resumption of various anticoagulants and antiplatelet agents. Specific drugs such as aspirin, clopidogrel, and heparin have outlined safe practices for catheter placement and removal. The guidelines emphasize the importance of monitoring coagulation parameters and adjusting practices based on individual patient circumstances.

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Tamil Selvan
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1K views3 pages

ASRA Guidelines

The ASRA guidelines provide recommendations for managing neuraxial anesthesia in patients on thromboprophylaxis, detailing the timing for discontinuation and resumption of various anticoagulants and antiplatelet agents. Specific drugs such as aspirin, clopidogrel, and heparin have outlined safe practices for catheter placement and removal. The guidelines emphasize the importance of monitoring coagulation parameters and adjusting practices based on individual patient circumstances.

Uploaded by

Tamil Selvan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

ASRA Evidence-Based Guidelines for Neuraxial Anesthesia in Patients on

Thromboprophylaxis
Drug Discontin Restart Indwelling Discontinu Restart Comments
uation Following Catheter ation Prior Following
Prior to Needle Placement to Removal
Placement Placement Removal
Antiplatel
et Agents
Aspirin Safe for all N/A Safe N/A N/A
categories
NSAIDs Safe for all N/A Safe N/A N/A
except
drugs
affecting
coagulatio
n
Clopidogr 5-7 days N/A Catheters N/A Immediate
el maintaine ly if
d for 1-2 loading
days dose
Ticlopidin 10 days Immediate Avoid N/A Immediate
e ly catheters ly if
loading
dose
Prasugrel 7-10 days If loading Avoid N/A N/A
dose 6h catheters
Ticagrelor 5-7 days 6h Avoid N/A 6h
catheters
Dipyridam 24h 6h Avoid N/A 6h
ole catheters
GP IIb/IIIa Avoid N/A Generally N/A N/A
Inhibitors until contraindi
platelet cated <4
function weeks
returns post-
surgery
Unfraction
ated
Heparin
IV Heparin 4-6h & 1h Safe 4-6h & 1h Check
confirm confirm platelet
normal normal count
coagulatio coagulatio before
n n needle
placement
if LMWH
>4 days
SC 4-6h & 1h Safe 5,000 U SC N/A
Heparin confirm bid or tid
(Low-dose normal
prophylax coagulatio
is) n
SC 12h & 1h Safety of 7,500- N/A
Heparin confirm catheters 10,000 U
(Higher- normal not SC bid or
dose coagulatio establishe 20,000
prophylax n d U/d
is)
SC 24h & N/A Avoid >10,000 U N/A
Heparin confirm catheters SC/dose
(Therapeu normal or
tic) coagulatio >20,000
n U/d
Low
Molecular
Weight
Heparin
Once Daily 12h 12h Safe 12h 12h Check
Prophylax platelet
is count
before
needle
placement
if LMWH
>4 days
Twice 24h 24-72h Avoid N/A N/A
Daily catheters
Prophylax
is
Therapeut 24h 24-72h Avoid N/A N/A
ic Dose catheters
Oral
Anticoagul
ants
Coumarin Ideally 5 No delay INR <1.5 N/A No delay Monitor
s days & INR before
INR <1.5 removal if
function
impaired
Apixaban 72h 6h N/A N/A 6h
Rivaroxab 72h 6h N/A N/A 6h Refer to
an ASRA
guidelines
for
specific
recommen
dations

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