Neuraxial block and low-molecular-weight heparin: Balancing perioperative analgesia and thromboprophylaxis

The efficacy and safety of low-molecular-weight heparins (LMWH) as postoper ative venous thromboembolism prophylaxis has been demonstrated in more than 60 clinical trials, including more than 20,000 patients (1). However, rece nt reports of spinal hematoma occurring spontaneously and in association wi th regional anesthesia (2, 3) have generated concern regarding the safety o f spinal or epidural anesthesia in patients receiving LMWH. This review wil l discuss the chronology of events leading to the current situation, as wel l as examine the possible factors contributing to the increased risk of spi nal hematoma in patients receiving LMWH.