Spinal anaesthesia and the use of anticoagulants

Best Pract Res Clin Anaesthesiol. 2003 Sep;17(3):443-9. doi: 10.1016/s1521-6896(02)00091-5.


This chapter addresses the increasing incidence of spinal haematoma after central neuraxis anaesthesia in patients receiving drugs that affect coagulation. Administration of low-molecular-weight heparins in the perioperative period is highlighted because these drugs remain the 'gold standard' for prophylaxis against deep-vein thrombosis. The performance of spinal anaesthesia in patients already receiving antiplatelet drugs is discussed--as well as special warnings in such a setting. In addition, issues such as those concerning the administration of unfractionated heparin, anti-vitamin K drugs or new antiplatelet and antithrombotic medications are addressed. Finally, specific recommendations regarding each class of drug are defined in order to avoid the occurrence of a rare but catastrophic event such as spinal haematoma.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Anesthesia, Spinal / adverse effects*
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Contraindications
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use
  • Hematoma, Subdural / chemically induced
  • Hematoma, Subdural / etiology
  • Hematoma, Subdural / prevention & control*
  • Heparin / administration & dosage
  • Heparin / therapeutic use
  • Heparin, Low-Molecular-Weight / administration & dosage
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Aggregation Inhibitors / therapeutic use
  • Risk Factors
  • Warfarin / administration & dosage
  • Warfarin / therapeutic use


  • Anticoagulants
  • Fibrinolytic Agents
  • Heparin, Low-Molecular-Weight
  • Platelet Aggregation Inhibitors
  • Warfarin
  • Heparin