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Heparins/Heparinoids (low molecular weight )

Spinal/Epidural Hematomas

  • Epidural or spinal hematomas may occur in patients who are anticoagulated with low molecular weight heparins (LMWH) or heparinoids and are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include:

    • Use of indwelling epidural catheters
    • Concomitant use of other drugs that affect hemostasis, such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants
    • A history of traumatic or repeated epidural or spinal punctures
    • A history of spinal deformity or spinal surgery
    • Optimal timing between the administration of LMWH and neuraxial procedures is not known.

    Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.

    Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis [see Warnings and Precautions (5.1) and Drug Interactions (7)].


Note: The following recommendations are included in the boxed warning data

  • Frequent monitoring for signs/symptoms of neurological impairment. If neurologic compromise is noted, urgent treatment is necessary.
  • Consider potential benefit/risk ratio prior to neuraxial intervention

FDA and Industry Communications

Index to FDA Drug Safety Information

Package Inserts


Additional Information

Updated January 2018