Regional anaesthesia and antithrombotic agents: instructions for use

Area of Science:

• Anesthesiology
• Pharmacology
• Clinical Guidelines

Background:

• Anticoagulant agents pose a significant risk of spinal hematoma, limiting regional anesthesia.
• Existing published guidelines for anticoagulant use in regional anesthesia are often incomplete or contradictory.

Purpose of the Study:

• To create a practical user guide by comparing major scientific society guidelines for regional anesthesia.
• To address the increasing number of patients on dual antiplatelet therapy requiring surgery.

Main Methods:

• Comparative analysis of guidelines from major scientific societies.
• Inclusion of patients undergoing dual antiplatelet therapy and requiring surgery.
• Consideration of regional anesthesia as an alternative to general anesthesia for elective and urgent procedures.

Main Results:

• Detailed description of major anticoagulant and antiplatelet drugs, including low molecular weight heparins (LMWH), aspirin, and thrombin inhibitors.
• Highlighting significant differences in LMWH usage between American and European guidelines.
• Special attention to new oral anticoagulant drugs (NOACs) and their limited applicability in regional anesthesia.

Conclusions:

• Substantial disparities and weak evidence exist across major guidelines.
• Operators must perform a thorough risk/benefit analysis before administering regional anesthesia in patients on anticoagulant therapy.