In such cases, drug therapy clinical equipoise should be discontinued immediately.
Prophylactic use of heparin in combination with epidural or spinal anesthesia or lumbar puncture, in rare cases can lead to the development of an epidural or spinal hematoma, resulting in prolonged or sustained paralysis may develop (see.
The risk of hematomas is increased by using the epidural or spinal catheter for anesthesia, with the concomitant use of drugs affecting coagulability of blood such as nonsteroidal anti-inflammatory drugs clinical equipoise, platelet aggregation inhibitors or the anticoagulants (see. Interaction with other drugs ), and in traumatic or repeated puncture.
when deciding on the time interval between the last heparin administration at prophylactic doses and the introduction or removal of an epidural or spinal catheter should be considered characteristic of the drug and the patient’s profile. After removal of the catheter following the dose of sodium bemiparin may be administered no earlier than 4 hours and only after completion of the surgical procedure.
The decision on the appointment of anticoagulant therapy in the context of epidural or spinal anesthesia is necessary to use extreme caution, including frequent monitoring to detect signs and symptoms of neurological disorders such as back pain, violation of sensitivity and motility (numbness and weakness of the lower limbs) and bowel dysfunction and bladder. Nursing staff should be trained to identify these signs and symptoms. Patients should be instructed as to the need for immediate information nurses or doctors in the event of these symptoms.
If you suspect the presence of an epidural or spinal hematoma clinical equipoise is urgently needed to establish a diagnosis of the adoption of therapeutic measures, up to the medullary decompression.
Effects on ability to drive vehicles and management mechanisms
The drug does not affect the ability to drive clinical equipoise vehicles and management mechanisms.