Neuraxial blocks and anticoagulant therapy.
Spinal and peridural anaesthesia has several advantages over general anaesthesia due to their low influence to endocrine and metabolic activity and their capacity to reduce postoperative surgical complications, intraoperative bleeding and deep venous thromboembolism incidence. Nevertheless, these anaesthesiologic techniques have a high risk of severe neurological events in patients treated with anticoagulant therapies and prophylaxis. However, this complication is rarely found in literature. It must be considered that spontaneous haematomas are possible, and these are independent of neuraxial blocks but associated to intrinsic factors or concomitant therapies. Anaesthetists must know the use and pharmacological properties of anticoagulant drugs in order to be able of giving up or modifying them during perioperative time, evaluating the risk of bleeding episodes and thrombotic events. An analysis of the literature has been made in order to establish favourable conditions, risk factors, international guide-lines and the real incidence of haemorrhagic complications associated to central blocks in patients being treated with drugs that modify their coagulative status. The survey of the literature and the international guide-lines shows that neuraxial anaesthesia should be performed in selected patients, respecting the free intervals of anticoagulant drugs, carrying out a correct postoperative neurological monitoring and evaluating, case by case, the risks and benefits of the procedure.
Colò
F
F
Unit of Anesthesia and Resuscitation, University of Udine, Udine, Italy.
Martinez López de Arroyabe
B
B
Divella
M
M
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D009407:Nerve Block; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012307:Risk Factors
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin