Thienopyridine therapy may be resumed immediately after needle placement/catheter removal, provided a loading dose of the drugs is not administered. If a loading dose is administered, we suggest a time interval of 6 hours between catheter removal and administration.

Based on labeling and surgical/procedural experience, the recommended time interval between discontinuation of ticagrelor therapy and needle placement is 5 days.

Neuraxial catheters should not be maintained with ticagrelor due to the rapid onset.

Ticagrelor therapy may be resumed immediately after needle placement/catheter removal, provided a loading dose of the drug is not administered. If a loading dose is administered, we suggest a time interval of 6 hours between catheter removal and administration.

The platelet GP IIb/IIIa inhibitors exert a profound effect on platelet aggregation. Following administration, the time to normal platelet aggregation is 24–48 hours for abciximab and 4–8 hours for eptifibatide and tirofiban. We recommend that needle placement should be avoided until platelet function—as impacted by the GP IIb/IIIa inhibitor—has recovered. Caution in patients on dual therapy who may still have residual NSAID effect.

Postoperative: Although GP IIb/IIIa antagonists are contraindicated within 4 weeks of surgery, should one be emergently administered in the postoperative period following a neuraxial or deep plexus/peripheral technique, we recommend the neuraxial infusion should be limited to drugs minimizing sensory and motor block to facilitate assessment of neurological function and that the patient be carefully monitored neurologically.

Timing of catheter removal is based on ongoing risk of thromboembolism and need for continued antithrombotic therapy and the potential for spinal bleeding during catheter maintenance and removal.

The risk of serious bleeding in the presence of residual cilostazol effect is unknown. Based on the elimination half-life, we suggest that needle placement be avoided for 2 days after discontinuation of cilostazol.

We suggest that neuraxial and deep plexus/peripheral catheters be removed prior to reinstitution of cilostazol therapy postoperatively.

We suggest that the first postoperative dose of cilostazol be administered 6 hours after neuraxial or deep plexus/peripheral catheter removal.