Epidural and Dvt ppx?

[europeman]

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Thought I would ask the experts! When you have an epidural in.... Is it okay to use lovenox for Dvt ppx? I was told your guidelines or something say sqh? The reason I find this odd is because in traumatic brain injury patients with intra-ventricular brain monitors or bolts we use lovenox preferably (just because lovenox is preferable in trauma overall). Someone explain! Thanks

 

[Arch Guillotti]

Single qd prophylactic dose shouldn't be a problem.

 

[cchoukal]

The American Society of Regional Anesthesia has some guidelines on this issue. Generally, as Arch said, prophylactic doses are considered safe, but both hospitals where I've practiced have had guidelines suggesting not to add other anticoagulants/anti-platelets/NSAIDs to LWMH. The issue is basically when you can insert/remove a catheter relative to a dose. ASRA used to say to remove a catheter 12 hrs after the last dose, and the next dose could be 2 hours later (there are/were some BID prophylactic regimens). The FDA recently suggested that post-removal dose should be > 4 hours, and ASRA has amended their statement to reflect this.

http://www.fda.gov/safety/medwatch/...tyalertsforhumanmedicalproducts/ucm373918.htm