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Slide 13 and 14:
Anticoagulants (heparin, LMWH, and warfarin)
can cause bleeding around the spinal cord (neuroaxial) in a few patients
who receive spinal or epidural anesthesia and analgesia. With the introduction
of LMWH as a prophylactic agent after hip and knee replacement, neuroaxial
bleeding has been seen in a small number of patients. In 1998, the American
Society of Regional Anesthesia offered recommendations about minimizing
bleeding in joint replacement patients who are being considered for
LMWH prophylaxis. Patients who receive pre-op LMWH should not undergo
spinal or epidural anesthesia. When indwelling catheters are used for
neuroaxial anesthesia or analgesia, LMWH should not be begun until at
least 2 hrs after the indwelling catheter has been removed. If indwelling
catheters are used for longer than 24 hrs post-op, an alternate method
of prophylaxis should be considered. The best alternate method is calf-high
pneumatic compression of the lower extremities.
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