title: [Neuraxial anaesthesia and NOACs].
abstract: BACKGROUND
  Cardiovascular comorbidities in surgical patients are frequent and have a substantial impact on the postoperative outcome. Neuraxial blockades are able to reduce perioperative morbidity and mortality. The increasing use of new oral anticoagulants (NOAC) requires a high level of attention, especially in patients undergoing neuraxial blockades or requiring postoperative analgesia.
  
  
  OBJECTIVE
  The goal of this article is to present the benefit of neuraxial anaesthesia and analgesia in patients with cardiovascular risks and perioperative management of NOAC in this setting.
  
  
  METHODS
  Review of the respective literature in PubMed during the last 25 years as well as presentation of the S1 guideline "Neuraxial anaesthesia and thrombo-embolic prophylaxis/antithrombotic medication" of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI).
  
  
  RESULTS
  Thoracic epidural anaesthesia and analgesia contribute to an improved outcome in surgical patients with high cardiovascular risk. In order to avoid severe complications in patients on NOACs undergoing neuraxial blockades the S1 guideline of the DGAI must be respected and close interdisciplinary consultations between anaesthetist, cardiologist and surgeon are mandatory.
  
  
  CONCLUSIONS
  In consideration of the respective guideline neuraxial blockades can be performed in cardiovascular risk patients on NOACs, since these techniques contribute to an improved postoperative outcome.
authors.affiliation: Klinik für Anästhesie, Operative Intensiv- u. Palliativmedizin, Städtisches Klinikum Solingen gGmbH, Gotenstraße 1, 42653, Solingen, Deutschland. standl@klinikumsolingen.de.
authors.forename: T
authors.initials: T
authors.lastname: Standl
mesh_terms: D000767:Anesthesia, Epidural; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use*; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications; D019983:Guideline Adherence; D006801:Humans; D019990:Perioperative Care / Q000379:methods; D012307:Risk Factors; D013923:Thromboembolism / Q000097:blood* / Q000517:prevention & control*; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D014812:Vitamin K
keywords: Cardiovascular diseases; Epidural analgesia; Perioperative management; Postoperative period; Treatment outcome