[Spinal hematoma associated with heparin therapy for venous thromboembolism prophylaxis]

Spinal hematoma is a rare and serious complication anesthesia. Risk factors for spinal hematoma during neuraxial anesthesia are anatomic abnormalities, impaired hemostasis and difficult needle placement. Japanese guideline for prevention of venous thromboembolism recommends low-dose unfractionated heparin (LDUH) to patients with moderate and high risk in perioperative period. LDUH is not contraindication for neuraxial anesthesia in this guideline. In order to reduce the risk of spinal hematoma in patients receiving heparin, it is recommended that the needle placement and catheter removal should be done when the anticoagulant effect of heparin is at the minimum. Postoperative evaluation of the neurological status is also important for early detection of a spinal hematoma.