Lumbar regional anaesthesia and prophylactic anticoagulant therapy. Is the combination safe?
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.
Wille-Jørgensen
P
P
Department of Surgical Gastroenterology F, Bispebjerg Hospital, Copenhagen.
Jørgensen
L N
LN
Rasmussen
L S
LS
D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000523:psychology; D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000523:psychology; D000925:Anticoagulants / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000209:etiology; D006801:Humans; D008297:Male; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D013923:Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants