title: The safe use of epidural anesthesia after subcutaneous injection of low-dose heparin in general abdominal surgery.
abstract: OBJECTIVE
  To determine if epidural anesthesia after the subcutaneous injection of low-dose unfractionated heparin (LDUH) in patients who undergo elective bowel surgery is safe with respect to hemorrhagic complications.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Two hospitals affiliated with the Université de Montréal.
  
  
  METHODS
  Fifty patients scheduled for elective bowel surgery.
  
  
  METHODS
  Subcutaneous injection of 5000 units of LDUH and elective surgery for colonic carcinoma, chronic diverticulosis or inflammatory bowel disease.
  
  
  METHODS
  Activated partial thromboplastin time (APTT), anti-IIa and anti-Xa heparin levels measured before and 2 and 4 hours after injection of LDUH.
  
  
  RESULTS
  In no case was the heparin anti-IIa or anti-Xa level higher than 0.20 U/mL, which is considered a significant detectable level of heparin.
  
  
  CONCLUSIONS
  LDUH given subcutaneously is not associated with significant detectable heparin levels, so epidural anesthesia should be safe when performed 2 hours after LDUH injection in patients who undergo general abdominal surgery in the absence of any other impairment of hemostasis.
authors.affiliation: Department of Hematology, Hôpital Maisonneuve-Rosement, Montreal, Que.
authors.forename: J
authors.initials: J
authors.lastname: Kassis
authors.forename: F
authors.initials: F
authors.lastname: Fugère
authors.forename: S
authors.initials: S
authors.lastname: Dubé
mesh_terms: D000767:Anesthesia, Epidural; D003110:Colonic Neoplasms / Q000097:blood / Q000601:surgery*; D004241:Diverticulum, Colon / Q000097:blood / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D065427:Factor Xa Inhibitors; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood / Q000601:surgery*; D007279:Injections, Subcutaneous; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D011300:Preoperative Care; D011516:Prothrombin / Q000037:antagonists & inhibitors; D013923:Thromboembolism / Q000097:blood / Q000517:prevention & control
chemical_list: D065427:Factor Xa Inhibitors; D011516:Prothrombin; C025337:Factor IIa; D006493:Heparin