Thromboprophylaxis and Its Implications in Regional Anesthesia

Abstract

Venous Thromboembolism (VTE) is an important cause of postoperative morbidity and mortality, especially when patients with co-morbid conditions (like obesity, coronary artery disease, or cancer) are on the rise. This necessitates the use of various thromboprophylaxis measures to prevent the occurrences of fatal VTE. However, the pharmacological thromboprophylaxis carries an inherent risk of bleeding, especially when the area of invasive work involves a potential space with risk of non-compressible arterial puncture. During neuraxial anesthesia, such bleeding into a closed space can result in spinal hematoma, which carries various neurological sequelae and requires urgent diagnosis and management. We will be discussing the relevant literature pertaining to the modalities of thromboprophylaxis, their mechanism of action and optimal management of such patients in the perioperative setting.