Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

• DOI: 10.1097/aap.0b013e3181c15c70
• Publication Date: 2009-12-28T08:17:09Z
• Authors: Terese T. Horlocker; Denise J. Wedel; John C. Rowlingson; F. Kayser Enneking; Sandra L. Kopp; Honorio T. Benzon; David L. Brown; John A. Heit; Michael F. Mulroy; Richard W. Rosenq...; Michael Tryba; Chun-Su Yuan
• Keywords: Neuraxial Blockade; Pain medicine

The actual incidence of neurologic dysfunction resulting from hemorrhagic complications associated with neuraxial blockade is unknown. Although the cited in literature estimated to be less than 1 150,000 epidural and 220,000 spinal anesthetics, recent epidemiologic surveys suggest that frequency increasing may as high 3000 some patient populations.Overall, risk clinically significant bleeding increase age,associated abnormalities cord or vertebral column, presence an underlying coagulopathy, difficulty during needle placement,and indwelling catheter sustained anticoagulation( particularly standard heparin low-molecular weight heparin). need for prompt diagnosis intervention optimize outcome also consistently reported. In response these safety issues, American Society Regional Anesthesia Pain Medicine (ASRA) convened its Third Consensus Conference on Anticoagulation. Practice guidelines recommendations summarize evidence-based reviews. However, rarity hematoma defies a prospective randomized study, there no current laboratory model. As result,the ASRA consensus statements represent collective experience recognized experts field anesthesia anticoagulation. These are based case reports, clinical series, pharmacology,hematology, factors surgical bleeding. An understanding complexity this issue essential management.