Peripheral Nerve Block and Anticoagulants

[VentdependenT]

Where do you all draw the limits for PTT/INR Heparin/LMWH PLAVIX and Peripheral Nerve blocks?

Does it matter?

Is it just entirely site dependent?

Curious as to yall's thoughts. Except for MMD who things PNB's are for the weak.

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[Noyac]

It depends on:

the case, risks benefits
the site of the block
the duration of anticoagulation
is the INR trend coming down or rising

I don't mess around in the spine with an INR greater than 1.5 in most circumstances.

I will however, do almost any peripheral block with the INR at this value and even greater if warranted. Plavix is 7 days as you know but I'll push it if the benefit is there and the risk is low (ie: FNB). 12 hrs for LMWH at 30 mg BID, if they are on the 40 mg Qday dosing I wait 24 hrs. but again I don't worry to much with certain blocks.

Is that what you are looking for?

 

[VolatileAgent]

our cutoff for neuraxials is INR=1.4 or 24 hours since last lmwh (or equivalent) dose.

for pnb's, we pretty much do it regardless of antiplatelet/anticoag therapy unless there's a compelling reason not to.

 

[VentdependenT]

VOlitile, thats what I'm getting at.

The data for Neuraxials and anticoagulation is bountiful but not so for PNB's.

I was just curious how the individuals here approach PNB's in these folks. Currently we will do em on folks who aren't coagulopathic or not on plavix/coumadin. We'll follow the same Lovenox/heparin guidelines for the neuraxials if working in the neck. Not so much for the extremities.

It seems to be more on an individual basis than on some broad guideline.


INR? Pfff I dunno, I'd go if its less than 2. Thats totally arbitrary however.

 

[VolatileAgent]

INR? Pfff I dunno, I'd go if its less than 2. Thats totally arbitrary however.

http://www.asra.com/consensus-statements/2.html

 

[VentdependenT]

INR of 2 for PNB's not neuraxials.