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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 12 h Surgery and anesthesia 24h after last dose if renal function is normal 2 half-lives/24 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