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Arterial and venous disease and deep vein thrombosis

BMJ 2000; 321 doi: (Published 21 October 2000) Cite this as: BMJ 2000;321:1018

Timing of thromboprophylaxis for general surgery should be discussed with anaesthetists

  1. David Crossley, consultant anaesthetist,
  2. Z Zych, consultant anaesthetist
  1. Princess Alexandra Hospital, Harlow, Essex CM20 1QX
  2. University College Hospital, London W1N 8AA

    EDITOR—The prevention of deep vein thrombosis and pulmonary embolism is a major consideration in all surgical patients. Unfortunately, the anaesthetic implications of thromboprophylaxis are rarely discussed, and this was once again the case in the article by Gorman et al.1

    The authors recommend low dose unfractionated heparin for the prevention of deep vein thrombosis in general surgical patients. The regimen described causes little risk of serious surgical bleeding. However, spinal or epidural anaesthesia performed in a patient who had received this treatment would be potentially dangerous, as this is the time of high or peak anticoagulant activity. This increases the risk of vertebral canal haematoma, which can lead to permanent paraplegia. The risk can …

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