EP022 Low but lethal: spinal hematoma in LMWH patients under neuraxial anesthesia

<h3>Background and Aims</h3> Neuraxial anesthesia (epidural and spinal) is widely used in surgical and obstetric procedures. However, in patients receiving thromboprophylaxis with low molecular weight heparin (LMWH), there is a risk of hemorrhagic complications, with spinal hematoma being the most feared due to its severe neurological consequences. Although its incidence is low, the clinical implications are significant. This systematic review aims to evaluate the incidence of spinal hematoma in patients receiving LMWH undergoing neuraxial anesthesia and identify associated risk factors. <h3>Methods</h3> A systematic search was conducted in PubMed, Embase, Cochrane Library, and Google Scholar using terms such as ‘Neuraxial anesthesia,’ ‘Low Molecular Weight Heparin,’ ‘Spinal hematoma,’ and ‘Risk factors.’ Filters included articles in English and Spanish published within the last 5 years. Clinical trials, cohort studies, case series, and systematic reviews were included; animal studies, pediatric studies, or those not reporting spinal hematoma incidence were excluded <h3>Results</h3> Of 2,819 identified articles, 50 studies met inclusion criteria. The overall incidence of spinal hematoma in patients with LMWH and neuraxial anesthesia was 0.1% (10 cases per 10,000 patients). Associated risk factors included advanced age, concomitant antiplatelet use, and therapeutic LMWH doses. Most studies recommended a 10–12-hour interval between the last LMWH dose and neuraxial block, with close postoperative neurological monitoring <h3>Conclusions</h3> The risk of spinal hematoma in patients receiving LMWH during neuraxial anesthesia is low (0.1%) but requires caution, particularly in those with risk factors. A safe interval between LMWH administration and neuraxial block, along with vigilant neurological monitoring, is recommended. Future research should focus on identifying high-risk subpopulations and strategies to further minimize bleeding risks