| Before catheter placement or removal | - Ensure an appropriate interval after last dose of anticoagulant or antiplatelet agent
- Document normal coagulation testing where appropriate (eg, after discontinuing therapeutic dose heparin or warfarin)
- Verify no other coagulation or platelet disorders*
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| During catheter placement | - Use the smallest needle possible needle (consider spinal rather than epidural technique)
- If appropriate, use a single injection rather than a continuous catheter
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| After catheter placement | - Ensure an appropriate interval between catheter placement or removal and the first dose of anticoagulant medication (only applies to medications considered safe during catheter maintenance)
- Ensure an appropriate interval between the last dose of anticoagulant medication and catheter removal
- Perform frequent neurologic checks
- Use smallest effective concentration of local anesthetic to allow for early recognition of sensory or motor changes
- Obtain emergency imaging if SEH is suspected¶
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| After neuraxial procedure or neuraxial catheter removal | - Ensure an appropriate interval between the neuraxial procedure or catheter removal and the first dose of an anticoagulant/antiplatelet agent
- Use a longer interval between traumatic neuraxial procedure and the first dose of an anticoagulant/antiplatelet agent
- Perform frequent neurologic checks
- Obtain emergency imaging if SEH is suspected¶
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| If SEH is detected | - Use the emergency reversal agent(s) appropriate for any anticoagulant medication
- Give emergency platelet transfusion if an antiplatelet medication is in effect
- Obtain emergency neurosurgical consultation for possible decompressive surgery
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