Aspirin (low-dose, monotherapy)
Hold before
No restriction — may continue
Restart after
No restriction
For Professionals · Quick reference
ASRA anticoagulation & neuraxial timing
Hold-before and restart-after intervals for neuraxial blockade and deep peripheral blocks, across antiplatelets, heparins, warfarin and the DOACs — with the renal caveats that change them. Search an agent or print for the block list.
Medically reviewed by
Dr. Saurabh Shukla, MBBS, DNB Anesthesiology
· Last updated June 2026
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Antiplatelet agents 11
NSAIDs (monotherapy)
Hold before
No restriction — may continue
Restart after
No restriction
▲ Clopidogrel
Hold before
5–7 days
Restart after
Resume after catheter removed (loading dose ≥24 h; maintenance immediately)
▲ Prasugrel
Hold before
7–10 days
Restart after
≥6 h after catheter removal
▲ Ticagrelor
Hold before
5–7 days
Restart after
≥6 h after catheter removal
▲ Ticlopidine
Hold before
10 days
Restart after
After catheter removal
Cilostazol
Hold before
2 days
Restart after
After catheter removal
Dipyridamole (extended-release)
Hold before
24 h
Restart after
After catheter removal
▲ GP IIb/IIIa — abciximab
Caveat: Avoid neuraxial within ~4 wk of these agents
Hold before
24–48 h (until platelet function recovers)
Restart after
—
▲ GP IIb/IIIa — eptifibatide / tirofiban
Caveat: Reduced clearance in renal impairment
Hold before
4–8 h
Restart after
—
Cangrelor
Hold before
3 h
Restart after
—
Unfractionated heparin 2
UFH — subcutaneous prophylaxis (≤5000 U BID/TID)
Caveat: Higher SC doses (>5000 U/dose or >15000 U/day): treat as therapeutic
Hold before
4–6 h and normal coagulation; check platelets if >4 days of therapy
Restart after
1 h
▲ UFH — intravenous therapeutic
Hold before
4–6 h and normal aPTT / ACT
Restart after
1 h
Low-molecular-weight heparin (LMWH) 2
▲ LMWH — prophylactic dose (e.g. enoxaparin 40 mg/day)
Caveat: CrCl <30: accumulates — extend interval / avoid
Hold before
12 h
Restart after
12 h after block, and ≥4 h after catheter removal
▲ LMWH — therapeutic dose (e.g. enoxaparin 1 mg/kg BID)
Caveat: CrCl <30: markedly prolonged — extend / avoid
Hold before
24 h
Restart after
24 h after block / catheter removal
Vitamin K antagonist 1
▲ Warfarin
Hold before
5 days and INR ≤1.4 (normalised)
Restart after
Resume per surgical plan; remove indwelling catheter only when INR <1.5
Direct oral anticoagulants (DOACs) 4
▲ Rivaroxaban
Caveat: CrCl 30–<50: consider longer; avoid if <30
Hold before
72 h (prophylactic & therapeutic)
Restart after
6 h after needle / catheter
▲ Apixaban
Caveat: Reduce/avoid with significant renal impairment
Hold before
72 h
Restart after
6 h after needle / catheter
▲ Edoxaban
Caveat: Renally cleared — extend if impaired
Hold before
72 h
Restart after
6 h after needle / catheter
▲ Dabigatran
Caveat: Predominantly renal — heavily CrCl-dependent; avoid if <30
Hold before
CrCl ≥80: 72 h · 50–79: 96 h · 30–49: 120 h
Restart after
6 h after needle / catheter
Parenteral thrombin / Xa agents 3
▲ Fondaparinux
Caveat: Renally cleared — avoid in renal impairment
Hold before
Prophylactic dose: 36–42 h (single-pass atraumatic needle); avoid with indwelling catheter
Restart after
6–12 h
▲ Argatroban
Caveat: Hepatically cleared
Hold before
Insufficient data — avoid; ensure normal aPTT
Restart after
—
▲ Bivalirudin
Caveat: Partly renal — prolonged if impaired
Hold before
~10 h and normal aPTT
Restart after
—
Thrombolytics & herbals 2
▲ Thrombolytics (alteplase / tPA, streptokinase)
Hold before
Avoid; ≥48 h and document fibrinogen recovery
Restart after
—
Garlic / Ginkgo / Ginseng
Hold before
No mandated interval — not a contraindication alone
Restart after
No restriction
Key sources
- Horlocker et al. ASRA Evidence-Based Guidelines, 4th ed. — Reg Anesth Pain Med 2018 — asra.com
- ESAIC Guideline on neuraxial blockade and antithrombotic agents (2022) — esaic.org
Intervals are general adult defaults and are modified by renal/hepatic function, the dose, and whether a catheter is indwelling. This page does not provide drug dosing. Always confirm against the current ASRA/ESAIC text and your institutional protocol before performing a block.