In patients receiving epidural or spinal analgesia, what should be done regarding DVT chemoprophylaxis?

In patients receiving epidural or spinal analgesia, the correct practice regarding DVT chemoprophylaxis is to reduce the dose of prophylaxis. This is important because the use of neuraxial anesthesia can potentially elevate the risk of bleeding, particularly in the setting of anticoagulation.

When epidural or spinal analgesia is employed, there is a delicate balance between providing adequate analgesia and minimizing the risk of complications such as hematoma formation. Reducing the dose of DVT prophylaxis helps to mitigate the possibility of significant bleeding or other complications related to the catheter or needle placement in the spinal column. Adjusting the prophylaxis ensures that the patient is still somewhat protected against thromboembolic events while also considering the unique risks associated with their anesthesia management.

Maintaining full dose prophylaxis could lead to an increased risk of bleeding complications, while completely prohibiting DVT prophylaxis could expose the patient to unnecessary risk of venous thromboembolism. The option to administer prophylaxis only if requested does not follow evidence-based guidelines and may leave patients unprotected from DVT, which could be harmful. Thus, careful dose reduction is a prudent approach in this clinical scenario.