Thromboembolism Prophylaxis and Major Regional Anaesthesia
Regional anaesthesia is presently facing a new challenge from a popular method of prophylaxis against deep vein thrombosis (DVT) and postoperative pulmonary embolism. Heparin subcoagulation has become widely accepted as a routine method of protection against thromboembolism in many centers, and some anaesthetists believe that this introduces a substantial hazard of bleeding from deep needle punctures. It is thought that heparin subcoagulation increases the risks of intraspinal oozing, haematoma formation and subsequent paralysis in subarachnoid and epidural anaesthesia, and that therefore spinal blockade may be contraindicated in the presence of a “minidose heparin” regimen . This paper will outline the problem and suggest appropriate policies.
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