Thromboprophylaxis, coagulation disorders, and regional anaesthesia

Area of Science:

• Anesthesiology
• Hematology
• Surgical Complications

Background:

• Surgery and trauma significantly alter coagulation, increasing perioperative thromboembolic risks.
• Thromboprophylactic treatment is essential but carries a risk of hemorrhagic complications.
• Regional anesthesia (spinal/epidural) in patients with coagulation issues or on anticoagulants raises concerns about spinal hematoma.

Purpose of the Study:

• To characterize patients at risk for deep vein thrombosis (DVT) and pulmonary embolism (PE).
• To summarize the efficacy of current thromboprophylactic regimens.
• To review the risks of spinal hematoma formation with combined pharmacological thromboprophylaxis and regional anesthesia, including in pregnancy.

Main Methods:

• Literature review and summary of documented efficacy of thromboprophylactic regimens.
• Analysis of patient risk factors for DVT and PE.
• Discussion of anesthetic considerations in patients with hemostatic disturbances.

Main Results:

• Effective thromboprophylaxis is necessary to mitigate thromboembolic complications.
• Systemic thromboprophylaxis can increase bleeding risk.
• Combined use of anticoagulants and regional anesthesia poses a risk of spinal hematoma.

Conclusions:

• Recommendations are provided for safe spinal and epidural anesthetic/analgesic routines in patients with hemostatic disturbances.
• Special considerations are highlighted for obstetric anesthesia in preeclamptic/eclamptic patients.
• Balancing thromboprophylaxis and regional anesthesia requires careful risk assessment.