title: New anticoagulants and regional anesthesia.
abstract: OBJECTIVE
  The use of pharmacological thromboprophylaxis in the perioperative period may conflict with regional anesthetic techniques in which maintaining hemostatic integrity is essential. Recently, new anticoagulants have been developed with more efficacy and a better safety profile. This article reviews the basis for the actual recommendations and the current status and management of these new drugs.
  
  
  RESULTS
  Recent studies have outlined that the risk of epidural hematoma after neuraxial anesthesia may be higher than estimated. Therefore, it is imperative to follow the published recommendations. The use of new anticoagulant drugs may take into account the pharmacological profile of each one to safely perform regional anesthesia, mainly the time to reach peak plasma level and half-life.
  
  
  CONCLUSIONS
  When new anticoagulant drugs are used for thromboprophylaxis in orthopedic surgery, the performance of neuraxial anesthetic techniques should be based on their pharmacology. If a peripheral blockade is chosen, these recommendations should be followed when a block is performed in a noncompressible area.
authors: Department of Anesthesia and Critical Care Medicine, Hospital Clínic Universitari, Valencia, Spain. juanvllau@gmail.com
authors: Juan V
authors: JV
authors: Llau
authors: Raquel
authors: R
authors: Ferrandis
mesh_terms: D000767:Anesthesia, Epidural / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use; D000069604:Dabigatran; D046748:Hematoma, Epidural, Spinal / Q000517:prevention & control*; D006801:Humans; D009025:Morpholines / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011720:Pyrazoles / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban; D013876:Thiophenes / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013876:Thiophenes; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran