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Can epidural anesthesia and warfarin be coadministered?
Javad Parvizi1, Eugene R Viscusi, Harrison G Frank
1Rothman Institute of Orthopedics, Department of Anesthesia, Thomas Jefferson University, Philadelphia, PA 19107, USA. parvj@aol.com
Clinical Orthopaedics and Related Research
|October 21, 2006
Summary
This study found no epidural hematomas in patients receiving epidural anesthesia and oral anticoagulation (warfarin) during knee arthroplasty. Controlled anticoagulation appears safe for combined epidural anesthesia and warfarin use in these procedures.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Hematology
Background:
- Epidural anesthesia offers intraoperative benefits and postoperative pain control for joint arthroplasties.
- Concerns regarding epidural hematoma risk often preclude coadministration with anticoagulation.
- Oral anticoagulation is frequently used for patients undergoing major orthopedic procedures.
Purpose of the Study:
- To determine the incidence of epidural hematoma in patients undergoing knee arthroplasty with combined epidural anesthesia and oral anticoagulation (warfarin).
- To assess the safety and complications associated with this combined anesthetic and anticoagulant regimen.
Main Methods:
- Retrospective chart review of 11,235 patients undergoing 12,991 knee arthroplasties.
- Patients received epidural anesthesia and oral anticoagulation (warfarin), with warfarin administered on the day of surgery.
- Epidural catheter removal typically occurred within 48 hours; detailed review for 1030 patients included international normalized ratio (INR) assessment.
Main Results:
- No cases of epidural hematoma were detected based on clinical examinations.
- For a subset of 1030 patients, the mean INR at epidural catheter removal was 1.54 (range, 0.93-4.25).
- No other complications related to the coadministration of epidural anesthesia and warfarin were identified.
Conclusions:
- Coadministration of epidural anesthesia and controlled oral anticoagulation (warfarin) is not associated with epidural hematoma in patients undergoing total knee arthroplasty.
- This combined approach appears safe, with no reported cases of neurologically significant epidural hematomas.
- Careful patient selection and monitoring of anticoagulation levels are crucial when combining these therapies.
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