Consensus Statement of American Society of Regional Anesthesia (ASRA) on LMWH as it relates to regional anesthetic use, adapted for use in combat casualties.

1. Antiplatelet or oral anticoagulant medications administered in combination with LMWH increases the risk of spinal hematoma. ASRA recommends against concomitant administration of antiplatelet drugs, standard heparin, dextran or coumadin, regardless of LMWH dosing regimen.

2. Before placement of an epidural catheter:

3. With an epidural catheter in place:

4. Before epidural catheter removal:

5. After epidural catheter removal:

6. Neuraxial anesthetic techniques should be avoided in patients who are receiving NSAIDS and LMWH.

7. For patients undergoing deep plexus or deep peripheral blocks, apply neuraxial recommendations

8. For patients undergoing other plexus or peripheral techniques, we recommend management (performance, catheter maintenance, and catheter removal) based on site compressibility, vascularity, and consequences of bleeding, should it occur. Twice daily prophylactic LMWH is acceptable with these types of regional nerve catheters.