[Modern anaesthesiological techniques and anticoagulation]

The variety of possibilities for medicamentous anticoagulation is constantly growing. Anesthesiologists and pain therapists are confronted with patients being treated with highly effective anticoagulatory or new antiaggregatory substances due to coronary heart disease, stroke or peripheral arterial disease. Especially these patients benefit from neuraxial blockades when undergoing cardiac surgery, revascularization surgery or amputations. The anaesthesiologist needs an overview concerning pharmacology, indications and side-effects of the anti- and procoagulatory substances and has to integrate this knowledge in the treatment concept to prevent haemorrhagic complications. This review depicts basics of coagulation, sites of action of currently applied anticoagulants and Austrian standards for performing modern central and peripheral nerve blocks under anticoagulatory medication. In general anaesthesia, too, the preoperative evaluation of preexisting anticoagulatory therapy is of high significance concerning the derivation of procedures for perioperative coagulation management. To prevent haemorrhagic complications in patients treated with anticoagulatory agents, recommendations concerning the following questions are given: time intervals between the application of anticoagulatory substances and punction, removal of catheters or general anaesthesia and operation; the choice and performance of the locoregional anaesthesiologic method and intraoperative coagulation analysis method; reversion of anticoagulation in acute situations.