Patient: I am Pregnant and due for C-Section in 2 days time. My health is fine and i don’t have any medical issues. The only thing that bothers me is that i am into one injection daily of innohep 3,500 since 6 weeks pregnancy. I would like to know when should i stop the injection before i go into Spine Block and C-Section procedure.
Doctor: Hello,Thanks for the query to ATD for an opinion,It is indeed a genuine query for pregnant patients on INNOHEP. The ideal time to stop it is 24 hrs before the spinal anaesthesia or surgery to prevent excessive blood loss during surgery. However this can be started back again after 8hrs of removal of epidural catheter post caesarean section and continued for at least 6 weeks post delivery in cases of thrombophilias ( both acquired or inherited if diagnosed).This is a very specific query on your part and hence i have tried to be very specific with regards to the management protocol.I hope i have answered your query,Wishing you safe surgery,Regards
Comments / Follow Ups
Patient: Thank you for the prompt answer, however, i would like to know why 24hr and not 12hr since i am into Prophylactic dose.
The decision for the duration of stopping the low molecular weight heparin before surgery is protocol dependent and two different schools of thought generally prevail. Some studies have suggested that in cases with 12hr protocol have showed increased blood loss during surgery even on being a prophylactic dose, 24 hrs is the protocol which is comparatively safer. But there are specialists who differ on their usage protocol. Even 12 hrs is safe as for the nature of surgery and spinal anaesthesia considering the 3 hr half life of LMWH.
So i agree with your argument about 12 hrs protocol as well.
Patient: Thank you again, I just want to know for the sake of my knowlege, if the life of the LMWH is only 3 hrs, is that mean the medicine requires less than 12 hrs to completely leach out of the Body? And what is the Probability/risk of having Blood transfusion, please. Regards
Doctor: Yes with a half life of 3 hrs , 12 hrs is sufficient time for the effect of lmwh to be leached out completely. The chances of blood transfusion due to lmwh per se is low but for surgery generally 2 pints of PRBC are always kept ready to cater for other obstetrical complications which may occur ( not always) during the surgery like uterine atony which can result in post partum haemorrhage. Hence blood always has to be kept ready anyways.