I have various patients on lovenox/enoxaparin (or being bridged with lovenox) who need pain procedures as described above. ASRA guidelines call for the med to be stopped 12 hours prior for prophylactic dosing and 24 hours prior for therapeutic dosing [Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications]
They note that some prophylactic doses increase to 1.5mg/kg/day for obese patients. And I had a patient being bridged with 120mg/day. Considering this was a bridge I’m guessing this was a therapeutic dose but by the recommendation this could be a prophylactic dose, making it difficult to decide when to stop a dose like this?