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It is with great interest that we read the Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition).1 The fifth edition (published January 2025, updated September 2025) provides important commentary on the use of intravenous unfractionated heparin (UFH) in patients with epidural catheters. The guidelines summarize data supporting the concomitant use of intravenous UFH in patients with epidural catheters primarily from three clinical contexts: 1- epidural catheters placed prior to vascular surgery; 2-neuraxial procedures performed before cardiac surgery; and 3-retrospective studies including patients with abnormal coagulation parameters.1