Use of anticoagulants in the setting of neuraxial anaesthesia (spinal, epidural, and combined spinal-epidural anaesthesia) or analgesia raises the risk of a spinal or epidural hematoma, which could be catastrophic.
The study medication should be stopped at least 60 hours before the invasive procedure or surgery. If the study medication has not been ceased for sufficient time to predict absence of anticoagulant effect, neuraxial anaesthesia should be avoided.
Specialist haematology advice is strongly recommended.
The study medication must not be restarted/administered if an epidural catheter is still in place.