Is anticoagulation and central neural blockade a safe combination?

Current Opinion in Anaesthesiology

Volumn 12, Issue 5, 1999, Pages 539-543

  Vandermeulen, Erik ^a  

^a UNIVERSITY HOSPITALS LEUVEN   (Belgium)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; HEPARIN; NONSTEROID ANTIINFLAMMATORY AGENT;

ANTICOAGULATION; HEART SURGERY; HEMATOMA; HEPARINIZATION; INDWELLING CATHETER; INTRAOPERATIVE PERIOD; NERVE BLOCK; PRIORITY JOURNAL; REVIEW; SPINAL CORD HEMORRHAGE; VASCULAR SURGERY; VERTEBRAL CANAL;

EID: 0033385524     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001503-199910000-00009     Document Type: Review

References (34)

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6. Horlocker T, Wedel DJ. Neuraxial block and low-molecular weight heparin: balancing perioperative analgesia and thromboprophylaxis. Reg Anesth Pain Med 1998; 23 (Suppl. 2):164-177. A detailed analysis of 40 cases of compressing vertebral canal haematomas that occurred with the combination of LMWH administration and central neural blockade in the USA. The authors clearly identify a number of risk factors and make consensus statements on central nerve block and anticoagulation.
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10. Yin B, Barrat S McG, Power I, Percy J. Epidural haematoma after removal of an epidural catheter in a patient receiving high-dose enoxaparin. Br J Anaesth 1999; 82:288-290. A recent case report on the development of a spinal haematoma after the inadvertent removal of an epidural catheter during thromboprophylaxis with unfractionated heparin and LMWH.
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26. Food and Drug Administration. Q & As: low molecular weight heparins/heparinoids and spinal/epidural anesthesia [web page]. http://www.fda.gov/medwatch/safety/1998/locq&a.htm[Accessed 15 April 1999]. This website contains the official position of the FDA on the combination of major neuraxial blocks and LMWH. It also contains a 180 page report of a consensus meeting of American experts on the matter.
27. Wysowski DK, Talarico L, Bacsanyi J, Botstein P. Spinal and epidural hematoma and low-molecular-weight heparin. N Engl J Med 1998; 338:1774. A warning by a number of FDA officials concerning the use of major neuraxial blocks in patients treated with LMWH. This warning does not necessarily represent the official position of the FDA.
28. Lumpkin ML. From the FDA: FDA Public Health Advisory. Anesthesiology 1998; 88:27A-28A. The official warning issued by the FDA on the combined use of LMWH and central neural block aimed at anaesthesiologists.
29. Nightingale SL. From the Food and Drug Administration: health advisory for low-molecular heparins and heparinoids. JAMA 1998; 279:346. The official warning issued by the FDA on the combined use of LMWH and central neural block aimed at all healthcare professionals.
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33. Checketts MR, Wildsmith JAW. Editorial II. Central nerve block and thromboprophylaxis - is there a problem? Br J Anaesth 1999; 82:164-167. European editorial that critically reviews the recommendations made by the FDA and Horlocker and Wedel, and that pleads in favour of a proper European approach.
34. Breivik H. Neurological complications in association with spinal and epidural analgesia - again [editorial]. Acta Anaesthesiol Scand 1998; 42:609-613. An interesting editorial that rounds up some complications of major neuraxial blockade and gives a number of recommendations to decrease the risk.