discontinue DVT ppx prior to lumbar puncture
- related: Neurology
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Because of reports of more than 100 cases of neuraxial bleeding from lumbar puncture and epidural procedures, on November 13, 2013, the US Food and Drug Administration issued a black box warning against such procedures in those receiving enoxaparin (choice A is correct).
Despite the rare number of overall events, the potentially devastating consequences from this complication led to this warning. Therefore, one should not perform a lumbar puncture until enoxaparin has been discontinued. For enoxaparin, lumbar puncture should be delayed for at least 12 h after administration of prophylactic doses such as those used for prevention of DVT. Longer delays (ie, 24 h) are appropriate to consider for patients receiving higher therapeutic doses of enoxaparin (1 mg/kg twice daily or 1.5 mg/kg once daily). One should wait at least 4 h after a lumbar puncture before restarting enoxaparin. These recommendations are also relevant for pregnant women who may require spinal and/or epidural procedures around the time of delivery.1