Spinal anaesthesia and the use of anticoagulants.
This chapter addresses the increasing incidence of spinal haematoma after central neuraxis anaesthesia in patients receiving drugs that affect coagulation. Administration of low-molecular-weight heparins in the perioperative period is highlighted because these drugs remain the 'gold standard' for prophylaxis against deep-vein thrombosis. The performance of spinal anaesthesia in patients already receiving antiplatelet drugs is discussed--as well as special warnings in such a setting. In addition, issues such as those concerning the administration of unfractionated heparin, anti-vitamin K drugs or new antiplatelet and antithrombotic medications are addressed. Finally, specific recommendations regarding each class of drug are defined in order to avoid the occurrence of a rare but catastrophic event such as spinal haematoma.
Narchi
Patrick
P
Anaesthesia Department, Centre Clinical, 16800 Soyaux, France. pnarchi@hotmail.com
D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000075202:Contraindications; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006408:Hematoma, Subdural / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D006493:Heparin