Surgical Bridging Therapy with Enoxaparin

Anticoagulation medication reduces your risk of blood clots by thinning your blood. Thinner blood increases the risk of bleeding during surgery. Therefore, you will need to stop taking your anticoagulation medication a few days before your surgery as it takes this time to lose its effect.

You will need to use Enoxaparin injections instead of your anticoagulation medication before and after your surgery. This is called ‘bridging therapy’.

Using Enoxaparin injections will continue to reduce your risk of blood clots.

You will be given a prescription for two days of Enoxaparin at your hospital pre-assessment appointment. You will need to take the prescription to the hospital pharmacy to obtain the supply.

Enoxaparin is a small needle injection that goes into the skin of your stomach. You will be given instructions on how to self-administer the injection at your pre-assessment appointment. Where possible we will ask that you try to self-administer the injection.

You should use a different area of your abdomen, approximately 1 inch apart, for each injection. You will be given a sharps bin for safe disposal of used syringes at your pre-assessment appointment. If you feel that you will be unable to self-administer the injection, we can make arrangements for this to be done at your GP surgery. If you are housebound and unable to attend the GP surgery, it may be possible to arrange for the district nurse to come to your home.

Patient’s personalised plan

(to be completed by a member of staff)

NHS Number:

Hospital Number:

Surname:

Forename:

Date of Birth:

Completed by

Full name:

Signature:

Date:

Please bring this plan with you to hospital when you come back for your surgery. Please show it to the doctors, nurses and pharmacist looking after you.

After surgery

After your surgery, you will be advised by the surgical team about restarting your usual anticoagulation medication at your usual dose. The bridging treatment with Enoxaparin will also be restarted when it is safe to do so.

On discharge

The bridging Enoxaparin will need to continue until your INR (blood test) is back in range. You will be given a 10-day supply of Enoxaparin when you leave the hospital. You will need to arrange for your blood test to be taken at your usual place, either at your GP practice or with the community anticoagulation nurses. This needs to happen three to five days after your operation.

The Enoxaparin will be stopped when your INR is in the therapeutic range. The time taken for this to happen varies for each patient and can take up to at least 10 days. If you are unable to administer the injection, the nursing staff will arrange for this to be done at your GP surgery or if you are housebound by the district nurses.

If you develop any signs or symptoms of bleeding when you are at home, please seek medical advice immediately.

Further information

If you have any further questions about your plan, or if your surgery is cancelled, please contact the Pre-operative Assessment Unit:
Telephone: 01305 254222 (Monday to Friday, 8am to 6pm, excluding bank holidays)

If you have any questions about your treatment on discharge, please contact your GP or the Community Anticoagulation Clinic:
Telephone: 01305 814007 (Monday to Friday, 9am to 7pm, excluding bank holidays)

Out of hours, please use the NHS 111 service.

About this leaflet

Authors: Ali Carless, Senior Sister, Pre-Assessment and Christine Dodd, Deputy Chief Pharmacist and Medication Safety Officer
Written: January 2017
Updated and approved: November 2019, April 2024
Review date: April 2027
Edition: v3

f you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk