Use of direct oral anticoagulants with regional anesthesia in orthopedic patients.
The use of direct oral anticoagulants including apixaban, rivaroxaban, and dabigatran, which are approved for several therapeutic indications, can simplify perioperative and postoperative management of anticoagulation. Utilization of regional neuraxial anesthesia in patients receiving anticoagulants carries a relatively small risk of hematoma, the serious complications of which must be acknowledged. Given the extensive use of regional anesthesia in surgery and the increasing number of patients receiving direct oral anticoagulants, it is crucial to understand the current clinical data on the risk of hemorrhagic complications in this setting, particularly for anesthesiologists. We discuss current data, guideline recommendations, and best practice advice on effective management of the direct oral anticoagulants and regional anesthesia, including in specific clinical situations, such as patients undergoing major orthopedic surgery at high risk of a thromboembolic event, or patients with renal impairment at an increased risk of bleeding.
Anaesthesia and Intensive Care Unit, Azienda Ospedaliera Istituto Ortopedico Gaetano Pini, 20122, Milan, Italy. Electronic address: gianluca.cappelleri@gpini.it.
Gianluca
G
Cappelleri
Anaesthesia and Intensive Care Unit, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy. Electronic address: andre.fanelli@gmail.com.
Andrea
A
Fanelli
D000284:Administration, Oral; D000765:Anesthesia, Conduction / Q000379:methods*; D000925:Anticoagulants / Q000008:administration & dosage*; D017326:Clinical Trials, Phase III as Topic; D065427:Factor Xa Inhibitors; D006801:Humans; D019637:Orthopedic Procedures; D000069552:Rivaroxaban / Q000008:administration & dosage
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban
Direct oral anticoagulant; Major orthopedic surgery; Neuraxial anesthesia; Perioperative management; Postoperative management