Neuraxial blocks and anticoagulant therapy

Area of Science:

• Anesthesiology
• Neurology
• Pharmacology

Background:

• Spinal and peridural anesthesia offer advantages over general anesthesia, including reduced endocrine/metabolic impact and fewer surgical complications.
• These techniques, however, pose a significant risk of severe neurological events in patients receiving anticoagulant therapy.
• Spontaneous hematomas, unrelated to neuraxial blocks, can also occur due to patient factors or concomitant medications.

Purpose of the Study:

• To analyze literature and establish guidelines for performing neuraxial anesthesia in patients on anticoagulant therapy.
• To identify favorable conditions, risk factors, and the incidence of hemorrhagic complications associated with central blocks in anticoagulated patients.

Main Methods:

• Literature review and analysis of international guidelines.
• Evaluation of pharmacological properties of anticoagulant drugs.
• Assessment of bleeding and thrombotic event risks.

Main Results:

• Neuraxial anesthesia in anticoagulated patients requires careful patient selection and adherence to drug-specific intervals.
• Postoperative neurological monitoring is essential to detect potential complications early.
• The incidence of hemorrhagic complications, while rare, necessitates a thorough risk-benefit assessment for each patient.

Conclusions:

• Neuraxial anesthesia can be safely administered in selected anticoagulated patients by managing perioperative drug timing and vigilant monitoring.
• Anesthesiologists must possess comprehensive knowledge of anticoagulant pharmacology to optimize patient safety.
• Individualized risk assessment is paramount for balancing the benefits of neuraxial anesthesia against the potential for bleeding complications.