The influence of new antithrombotic drugs on regional anesthesia.
OBJECTIVE
Antithrombotic drugs are known to increase the risk of spinal epidural hematoma after neuraxial blockade. During the last few years, several new anticoagulants have been introduced, some of them more potent than the drugs currently available. More potency, however, may also indicate a higher risk of bleeding.


RESULTS
Case series from the last few years indicate that spinal epidural hematoma is more common then previously estimated, with a prevalence from 1: 100,000 in obstetric patients to as high as 1: 3,600 in female orthopedic patients. In order to diminish this risk, most national societies have issued guidelines in which time intervals were established between administration of antithrombotic drugs and performance of neuraxial blockade.


CONCLUSIONS
Guidelines are perceived to be capable of reducing the incidence of spinal epidural hematoma with the inherent risk of permanent paraplegia. These guidelines, however, will only be a valuable aid for clinicians if they are constantly updated and newer antithrombotic drugs are included. Although the resurge of peripheral nerve blocks may diminish patient hazards, deep nerve blocks such as lumbar sympathetic blockade are not devoid of serious complications and should probably be handled in the same way as neuraxial blockade.
Gogarten
Wiebke
W
Department of Anesthesiology and Intensive Care, University of Muenster, Muenster, Germany. gogarten@anit.uni-muenster.de
D000244:Adenosine Diphosphate / Q000037:antagonists & inhibitors; D000765:Anesthesia, Conduction / Q000009:adverse effects*; D000767:Anesthesia, Epidural / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D006348:Cardiac Surgical Procedures; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000077425:Fondaparinux; D046748:Hematoma, Epidural, Spinal / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D028321:Plant Preparations / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011134:Polysaccharides / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D028321:Plant Preparations; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011134:Polysaccharides; D000244:Adenosine Diphosphate; D000077425:Fondaparinux; D001241:Aspirin