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Neuraxial timing on antithrombotic therapy

Published hold intervals for a neuraxial or deep plexus block, a catheter removal, or the first dose after one, in an ADULT patient. The guideline states obstetric practice separately and this table does not carry it. The interval is the guideline's; the decision to proceed is not, and stays with the clinician.

Event

Your local time.

Enter the time of last dose to see the earliest permissible time.
  • A residual apixaban plasma level below 30 ng/mL, or a residual anti-Xa activity level at or below 0.1 IU/mL, is the alternative the guideline states to waiting the full interval.
  • After a traumatic (bloody) puncture the manufacturer states a 48 hour delay before the next apixaban dose.

Intervals are the published minima for the stated agent, dose tier, and event. They do not decide whether a block may proceed: concurrent drugs that affect hemostasis, the puncture itself, and the patient's own risk all sit outside this arithmetic.

Formula

  • Earliest permissible time = stated time + the published interval for that agent, dose tier, and event
  • Renal function selects the interval where the guideline publishes a creatinine clearance band
  • Where the guideline states a range, the longer end is carried

Source

  • Kopp SL, Vandermeulen E, McBane RD, Perlas A, Leffert L, Horlocker T. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition). Reg Anesth Pain Med 2025. doi:10.1136/rapm-2024-105766

Clinical reference only. Verify independently; clinical judgment governs.