• Dana Archibald, Thomas Stambulic, Morgan King, Anthony M-H Ho, Minnie Fu, Rodrigo M E Lima, Lais H N E Lima, and Glenio B Mizubuti.
• Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
• J. Cardiothorac. Vasc. Anesth. 2023 Apr 1; 37 (4): 555560555-560.

ObjectivesThe 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.DesignA retrospective analysis between April 2012 and April 2022.SettingA single (academic) center.ParticipantsVascular surgery patients.InterventionsIntravenous heparin administration.Measurements And Main ResultsAll (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.ConclusionsThe 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.Copyright © 2022 Elsevier Inc. All rights reserved.

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