Neuraxial anesthesia and analgesia in the presence of standard heparin

Therapeutic anticoagulation dosages of standard heparin are commonly used during the perioperative period in vascular surgery and cardiac surgery patients (1). Low-dose heparin also is frequently used for prophylaxis against the development of venous thromboembolism in general, orthopedic, and urologic surgery (2). Neuraxial anesthetic techniques are often attractive for these patients, because these techniques may provide reduced morbidity and improved postoperative analgesia (3). However, the use of neuraxial procedures in the presence of standard heparin may be associated with an increased risk of epidural hematoma (4). Herein we review the pharmacology of standard heparin. In addition, we review clinical investigations examining the risks of spinal/epidural hematoma associated with neuraxial anesthesia in the absence and presence of heparin. From these data, we provide a consensus statement on the risk of performing neuraxial procedures in the presence of standard heparin.