Suggested Discontinuation of Anticoagulation or Antiplatelets before Spine Procedures

(PRESCRIBING PHYSICIAN MUST PROVIDE WRITTEN DOCUMENTATION TO STOP THESE MEDICATIONS)

PO medications

Coumadin - stop 4-5 days prior, check INR <1.4

Plavix (clopidogrel) - stop 7 days prior

Ticlid (ticlopidine) - stop 14 days prior

Aggrenox (aspirin + dipyridamole) - stop 7 days prior

Persantine (dipyridamole) - stop 7 days prior

Pletal (cilostazol) - stop 7 days prior

Effient (prasugrel) - stop 7 days prior

Pradaxa (dabigatran) - stop 3 days prior

Xarelto (rivaroxaban) - stop 48 hours prior, resume in 6 hours

Eliquis (apixaban) - stop 48 hours prior, resume with evening dose

Aspirin - no need to stop

NSAIDS - no need to stop

Herbal medicines - no need to stop

IV/IM/SQ medications

IV Heparin - stop 4 hours prior, check PTT, hold for 1 hour after procedure

SQ Heparin - no need to stop (unless > 10,000 units/day, follow IV heparin guidelines)

LMWH (Lovenox (enoxaparin), Fragmin (dalteparin), Innohep (tinzaparin))

High dose (“treatment dose”) = 40 - 200 mg (1 - 1.5 mg/kg) - stop 24 hours prior, hold for 24 hours after procedure

Low dose (for thromboprophylaxis) = 40 mg (0.5 mg/kg) - stop 12 hours prior, hold for 24 hours after procedure

Reapro (abciximab) - stop 24 hours prior

Aggrastat (tirofibam) - stop 8 hours prior

Integrelin (eptifibatide) - stop 8 hours prior