How long after the last dose of dalteparin (Fragmin) should one wait prior to placement of a thoracic epidural for a patient on DVT prophylaxis?

How long after the last dose of dalteparin (Fragmin) should one wait prior to placement of a thoracic epidural for a patient on DVT prophylaxis?

• A. 12 hours
• B. 24 hours
• C. 30 hours
• D. 72 hours

Answer: (A)

Timing of neuraxial anesthesia in patients receiving LMWH prophylaxis is what this question tests. For dalteparin used as DVT prophylaxis, the safer practice is to wait 12 hours after the last dose before placing a thoracic epidural. This interval helps ensure that the anticoagulant effect diminishes enough to lower the risk of spinal or epidural hematoma, a rare but serious complication. If the dosing were therapeutic rather than prophylactic, a longer interval (around 24 hours) would be used. The other time spans listed are not the standard recommendation for prophylactic dalteparin.

Timing of neuraxial anesthesia in patients receiving LMWH prophylaxis is what this question tests. For dalteparin used as DVT prophylaxis, the safer practice is to wait 12 hours after the last dose before placing a thoracic epidural. This interval helps ensure that the anticoagulant effect diminishes enough to lower the risk of spinal or epidural hematoma, a rare but serious complication. If the dosing were therapeutic rather than prophylactic, a longer interval (around 24 hours) would be used. The other time spans listed are not the standard recommendation for prophylactic dalteparin.