Blood Thinner Policy
Having an injection in your spine is considered a high risk procedure more so than having major abdominal surgery. Because of this, certain blood thinners MUST be stopped before you are able to undergo a spinal injection or else catastrophic life threatening complications can occur. Prior to changing/stopping any of your current medications, please discuss this with your primary care provider. Always read the labels of all over the counter products you use to be sure you know the ingredients they contain before taking them. (moved)
Aspirin: This medication affects your platelets and prevents your blood from clotting, therefore increasing the chances of bleeding. You must stop taking aspirin and any other medications containing Aspirin for at least 7 days prior to your procedure. You do not have to stop prescribed baby aspirin (81 mg) doses. Aspirin products include but are not limited to:
Salicylate, Ecotrin, Excedrin, Bayer, Bufferin, Midol, Anacin, Goody’s Powder, BC Powders, Pepto Bismol, Alka-Seltzer, Fiorinal, Soma-compound, and various topical preparations containing Aspirin.
Blood Thinners/Anti-coagulants: These products also interfere with your ability to clot normally thereby making you bleed more easily. These include but are not limited to (alphabetize):
· Fragmin (Dalteparin)-Hold at least 24 hours before the procedure
· Lovenox (Enoxaparin)–Hold at least 48 hours before the procedure
· Heparin-Hold at least 6 hours before the procedure
· Plavix (Clopidogrel)-Hold at least 7 days before the procedure
· Reopro (Abciximab)-Hold at least 48 hours before the procedure
· Integrelin (Eptifibatide)-Hold at least 12 hours before the procedure
· Effient (Prasugrel)-Hold at least 7 days before the procedure
· Aggrastat (Tirofiban)-Hold at least 12 hours before the procedure
· Reopro (Abciximab)-Hold at least 48 hours before the procedure
· Pletal (Cilostazol)-Hold at least 4 days before the procedure
· Arixtra (Fondaparinux)-Hold at least 7 days before the procedure
· Lovenox (Heparin)-Hold for 24 hours before the procedure
· Ticlid (Ticlodipine)-Hold for 14 days before the procedure
· Trental (Pentoxifylline)-Hold for at least 7 days before the procedure
· Aggrenox/Persantine (Dipyridamole)-Hold at least 7 days before the procedure
· Warfarin/Coumadin must be stopped at least 5 days before your procedure.
Newer blood thinners:
· Xarelto (rivaroxaban)- Hold at least 72 hours before the procedure.
· Pradaxa (dabigatran)- Hold at least 4 days before the procedure.
· Eliquis (apixaban)- Hold at least 72 hours before the procedure.
· Savaysa (Edoxaban)-Hold at least 72 hours before the procedure.
Diabetics
Having a steroid injection can increase your blood sugars. Please make sure to check your blood sugars prior to your procedure. If it is too high, your procedure may need to be cancelled. If your blood sugars do become elevated above your normal baseline, please contact your PCP and/or endocrinologist immediately so that they can advise you on how to adjust your medications to help lower this.
Also, if you are on Glucophage, please notify the staff as it can interact with contrast dye.
Pregnancy
· If you are pregnant or possibly believe you may be pregnant, please inform the staff. Certain procedures require the use of fluoroscopy which is contraindicated in pregnancy as it can harm your unborn baby.
Sedation
· If you are scheduled for and/or require/request sedation prior to your procedure, please notify our staff prior to your scheduled appointment. On the morning of your appointment:
· No solid food for 6 hours before your procedure.
· You may have clear liquids up to 3 hours before your procedure. Clear liquids would be water, apple and cranberry juice, ginger ale (no milk).
Post Procedure
· You should not drive, operate machinery or make legal decisions for 24 hours after the procedure. Please arrange for someone to drive you home. Otherwise, your procedure may be rescheduled.
If you have questions or concerns regarding these guidelines, please address them with your prescribing provider prior to your scheduled appointment.
DISCLAIMER: Please do not stop any anticoagulants unless you gain permission from your Primary Care Physician and/or prescribing provider (PCP). We must have written documentation from your PCP agreeing for you to hold your blood thinner medication for the recommended time frame before any procedure can be performed. Please fax this to our Roanoke office at 540-206-3826 or Christiansburg at 540-251-3476.