[The use of antithrombotic drugs during various surgical procedures]

Neuraxial blockade has been shown to provide essential benefits in terms of reduced perioperative morbidity and mortality. Case series from recent years indicate that spinal epidural hematoma is more common than previously estimated, with incidences of 1:200,000 in obstetric patients and as high as 1:3,600 in female orthopedic patients. To lower this risk, societies worldwide have issued guidelines establishing recommended time intervals between administration of antithrombotic drugs and performance of neuraxial blockade. If adherence to these intervals imposes a high risk of theomboembolic complications, neuraxial blockade should be withheld in favor of continued antithrombotic therapy. In such patients an alternative plan for postoperative pain management such as patient-controlled intravenous analgesia or peripheral nerve blocks should be established. In patients on continued acetylsalicylic acid therapy, neuraxial blockade may be performed if thromboembolism prophylaxis is not administered concurrently.