European practice guidelines: Thromboembolism prophylaxis and regional anesthesia

Since the early 1980s, mast patients in central continental Europe schedule d for any in-hospital surgical procedures receive pharmacological thromboem bolism prophylaxis, most frequently standard heparin (SH) or low-molecular- weight heparin (LMWH). Although several million neuraxial blocks are perfor med in these countries yearly (e.g., approximately 1.5 million in Germany p er year), the reported incidence of clinically important spinal bleeding in these patients resulting in permanent neurological dysfunction is extremel y low (1,2). However, one should recognize that 70-75% of neuraxial blocks performed in Europe are single-shot spinal blocks (Table I). Based on these experiences, as well as experimental and clinical studies an d large case series, local and official guidelines on hemostatic requiremen ts for neuraxial block have been developed in several European countries (2 -14). I believe Germany is the only country with official guidelines; they were approved by the German Society of Anesthesiology and Intensive Care Me dicine (15) and are cited in this study. Nevertheless, local guidelines in most other European countries do not differ significantly from the German g uidelines.