Table 1 Anticoagulants and antiplatelets summarised [39]
From: Management of proximal femur fractures in the elderly: current concepts and treatment options
Drug | Elimination half-life | Management | Acceptable to proceed with spinal |
|---|---|---|---|
Aspirin | Irreversible effect on platelets | Proceed with surgery | Continue |
Clopidogrel | Irreversible effect on platelets | Proceed with surgery, monitor for blood loss, consider platelet transfusion if concerns regarding bleeding | If anti-platelet monotherapy. General anesthesia if dual therapy |
Ticagrelor | 8–12 h | Proceed with surgery with general anaesthetic. Monitor for blood loss. Consider platelet transfusion if concerns regarding bleeding | 5 days or post platelet transfusion at least 6 h post last dose |
Warfarin | 4–5 days | 5 mg vitamin K i.v. and repeat INR after 4–6 h. This can be repeated or consider Beriplex for immediate reversal | If INR < 1.5 |
Apixaban | 12Â h | Surgery and anesthesia 24h after last dose if renal function is normal | 2 half-lives/24Â h after last dose if renal function is normal |
Dabigatran | 12–24 h | Surgery and anesthesia if thrombin time normal or idarucizumab for immediate reversal if thrombin time prolonged | If thrombin time normal or 30 min following idarucizumab infusion |
Rivaroxaban | 7–10 h | Surgery and anesthesia 24 h after last dose if renal function normal | 2 half-lives/24 h after last dose if renal function normal |
Low-molecular weight heparin sub-cutaneous prophylactic dose | 3–7 h | Last dose 12 h pre-op | 12 h |
Low-molecular weight heparin sub-cutaneous treatment dose | 3–7 h | Last dose 12–24 h pre-op. Monitor for blood loss | 24 h |
Unfractionated i.v. heparin | 1–2 h | Stop i.v. heparin 2–4 h pre-op | 4 h |