Balancing Bleeding and Clotting Risks: Updated LP Guidelines in Antithrombotic Care- by Dr. Chokri Ben Lamines
Updated Peri-Procedural Guidelines at a Glance on X։
Explore Dr. Chokri Ben Lamine’s evidence-based guide on safely performing lumbar puncture in patients receiving anticoagulants or antiplatelet therapy. This concise reference outlines when to pause, bridge, or proceed—based on the latest international recommendations․
“Lumbar Puncture & Bleeding Risk: Summary
-When to stop or continue common agents (aspirin, warfarin, DOACs)
-Risk stratification for bleeding vs. thrombosis
-Bridging protocols for high-risk patients
-Practical timing for safe LP executionStop Antithrombotics Before LP
Antiplatelets
• Aspirin 75mg: Continue
• Clopidogrel: 7d (aspirin cover) → LP after 6h
• Prasugrel/Ticagrelor: 7d → LP after 6h
• Dipyridamole: 24h → LP after 6h
• Tirofiban/Eptifibatide: 4–8h → LP after 4h
• Abciximab: 48h → LP after 24hAnticoagulants
• Warfarin: 5d → INR ≤1.4 → LP → restart 12h
• LMWH (proph): 12h → LP → restart 4h
• LMWH (Tx): 24h → LP → restart 4h (24h if traumatic)
• Fondaparinux (proph): 36h → LP → restart 6–12h
• Fondaparinux (Tx): Avoid LP
• UFH IV: –6h → LP → restart 1h
• Rivaroxaban/Apixaban: 24h → LP → restart 6h
• Dabigatran: 48h → LP → restart 6h”
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