Lumbar regional anaesthesia and prophylactic anticoagulant therapy. Is the combination safe?

Anaesthesia. 1991 Aug;46(8):623-7. doi: 10.1111/j.1365-2044.1991.tb09707.x.

Abstract

A survey has been carried out in all Danish anaesthetic departments (n = 80) regarding the attitude towards the use of epidural/spinal lumbar analgesia in patients who were receiving prophylactic anticoagulant therapy for the prevention of thromboembolism. About 60% of the departments used the techniques in patients receiving low-dose heparin and no side effects had been experienced. Spinal and epidural anaesthesia were in general regarded as being contraindicated in patients fully anticoagulated with vitamin K antagonists. In the world literature, the attitude towards the combination is conflicting. No randomised trial has been performed and complications are almost entirely confined to patients fully anticoagulated with vitamin K antagonists. Only one case of an epidural haematoma has been recorded when subcutaneous low-dose heparin was used as thromboprophylaxis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anesthesia, Epidural / adverse effects*
  • Anesthesia, Epidural / psychology
  • Anesthesia, Spinal / adverse effects*
  • Anesthesia, Spinal / psychology
  • Anticoagulants / therapeutic use*
  • Attitude of Health Personnel
  • Female
  • Hematoma, Epidural, Cranial / etiology
  • Humans
  • Male
  • Subarachnoid Hemorrhage / etiology
  • Thromboembolism / prevention & control*

Substances

  • Anticoagulants