Applying the ASRA guidelines to the use of low-molecular-weight heparin thromboprophylaxis in major orthopedic surgery

Although low-molecular-weight heparin (LMWH) is a widely used form of thromboprophylaxis in orthopedic surgery, concerns remain over the concomitant use of regional anesthesia (RA)/postoperative regional analgesia (PRA) stemming from reports in the 1990s of spinal hematoma associated with this combination. One of the objectives of the Second American Society of Regional Anesthesia (ASRA) Consensus Conference was to address the safety of LMWH in combination with neuraxial anesthesia. The guidelines are designed in part to help orthopedic surgeons already using or contemplating the use of LMWH prophylaxis to avoid or minimize potential complications arising from its use with RA/PRA. Clinicians should consult the ASRA guidelines for recommendations on total daily dose, timing of the first postoperative dose, and dose schedule for anticoagulants used in conjunction with RA/PRA.