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Published on: January 18, 2018
New anticoagulants and regional anesthesia
Juan V Llau1, Raquel Ferrandis
1Department of Anesthesia and Critical Care Medicine, Hospital Clínic Universitari, Valencia, Spain. juanvllau@gmail.com
Current Opinion in Anaesthesiology
|July 2, 2009
Summary
New anticoagulant drugs require careful management for safe regional anesthesia. Understanding their pharmacology is crucial to minimize the risk of epidural hematoma during thromboprophylaxis, especially in orthopedic surgery.
Area of Science:
- Anesthesiology
- Pharmacology
- Hematology
Background:
- Perioperative pharmacological thromboprophylaxis can conflict with regional anesthesia.
- Maintaining hemostatic integrity is critical for regional anesthetic techniques.
- New anticoagulants offer improved efficacy and safety profiles.
Purpose of the Study:
- Review the basis for current recommendations on new anticoagulant drugs.
- Discuss the current status and management of novel anticoagulants.
- Provide guidance on safely performing regional anesthesia with new anticoagulants.
Main Methods:
- Literature review of recent studies on anticoagulant use and neuraxial anesthesia.
- Analysis of pharmacological profiles of new anticoagulant drugs.
- Evaluation of published recommendations for thromboprophylaxis.
Main Results:
- The risk of epidural hematoma after neuraxial anesthesia may be underestimated.
- Adherence to published recommendations is imperative.
- Pharmacological profiles (peak plasma level, half-life) of new anticoagulants are key for safe regional anesthesia.
Conclusions:
- Neuraxial anesthesia with new anticoagulants for thromboprophylaxis in orthopedic surgery must consider drug pharmacology.
- Recommendations should be followed for peripheral blocks in noncompressible areas.
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