Systemic Heparinization After Neuraxial Anesthesia in Vascular Surgery: A Retrospective Analysis

Published:December 17, 2022DOI:


      The American Society of Regional Anesthesia and Pain Medicine's guidelines recommend a 1-hour interval after neuraxial anesthesia (NA) before systemic heparinization to mitigate the risk of spinal hematoma (SH). The study authors aimed to characterize the time interval between NA and systemic heparinization in vascular surgery patients (primary outcome). The secondary outcomes included the historic incidence of SH, and risk estimation of the SH formation based on available data. Heparin dose, length of surgery, difficulty and/or the number of NA attempts, and patient demographics were recorded.


      A retrospective analysis between April 2012 and April 2022.


      A single (academic) center.


      Vascular surgery patients.


      Intravenous heparin administration.

      Measurements and Main Results

      All (N = 311) vascular patients were reviewed, of whom 127 (5 femoral-femoral bypass, 67 femoral-popliteal bypass, and 55 endovascular aneurysm repairs [EVAR]) received NA and were included in the final analysis. Patients receiving general anesthesia alone (N = 184) were excluded. Neuraxial anesthesia included spinal (N = 119), epidural (N = 4), or combined spinal-epidural (N = 4) blocks. The average time between NA and heparin administration was 42.8 ± 22.1 minutes, with 83.7% of patients receiving heparin within 1 hour of NA. The time between NA and heparin administration was 40.4 ± 22.3, 50.1 ± 23.4, and 31.3 ± 12.5 minutes for femoral-femoral bypass, femoral-popliteal bypass, and EVAR, respectively. Heparin was administered after 1 hour of NA in 20% of femoral-femoral bypass, 27% of femoral-popliteal bypass, and 3.9% of EVAR patients. No SHs were reported during the study period.


      The vast majority of vascular surgery patients at the authors’ center received heparin within 1 hour of NA. Further studies are required to assess if their findings are consistent in other vascular surgery settings and/or centers.

      Key Words

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        • Hutton M
        • Brull R
        • Macfarlane AJR
        Regional anaesthesia and outcomes.
        BJA Educ. 2018; 18: 52-56
        • Kettner SC
        • Willschke H
        • Marhofer P
        Does regional anaesthesia really improve outcome?.
        Br J Anaesth. 2011; 107: i90-i95
        • Agarwal A
        • Kishore K
        Complications and controversies of regional anaesthesia: A review.
        Indian J Anaesth. 2009; 53: 543-553
        • Liu SS
        • McDonald SB
        Current issues in spinal anesthesia.
        Anesthesiology. 2001; 94: 888-906
        • Hermanides J
        • Hollmann MW
        • Stevens MF
        • et al.
        Failed epidural: Causes and management.
        Br J Anaesth. 2012; 109: 144-154
        • Horlocker TT
        • Vandermeuelen E
        • Kopp SL
        • et al.
        Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition).
        Reg Anesth Pain Med. 2018; 43: 263-309
        • Ruff RL
        • Dougherty JH
        Complications of lumbar puncture followed by anticoagulation.
        Stroke. 1981; 12: 879-881
        • Ho AM-H
        • Ho AK
        • Mizubuti GB
        • et al.
        Estimating the risk of a rare but plausible complication that has not occurred after n trials.
        Anesth Analg. 2018; 127: 1259-1263
        • Bodilsen J
        • Mariager T
        • Vestergaard HH
        • et al.
        Association of lumbar puncture with spinal hematoma in patients with and without coagulopathy.
        JAMA. 2020; 324: 1419
        • Karthikesalingam A
        • Thrumurthy SG
        • Young EL
        • et al.
        Locoregional anesthesia for endovascular aneurysm repair.
        J Vasc Surg. 2012; 56: 510-519
        • Smith LM
        • Cozowicz C
        • Uda Y
        • et al.
        Neuraxial and combined neuraxial/general anesthesia compared to general anesthesia for major truncal and lower limb surgery.
        Anesth Analg. 2017; 125: 1931-1945