Regional Anesthesia in Patients on Anticoagulation Therapies—Evidence-Based Recommendations

• Published in: Current pain and headache reports Vol. 23; no. 9; pp. 67 - 7
• Main Authors: Kaye, Alan David, Brunk, Andrew J., Kaye, Aaron J., Renschler, Jordan S., Hart, Brendon M., Anandi, Prathima, Patil, Shilpa, Cornett, Elyse M., Fox, Charles J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2019; Springer Nature B.V
• Subjects: Administration, Oral; Anesthesia; Anesthesia, Conduction - adverse effects; Anesthesia, Conduction - methods; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Evidence-Based Medicine - methods; Evidence-Based Medicine - trends; FDA approval; Hemorrhage - chemically induced; Hemorrhage - diagnosis; Hemorrhage - prevention & control; Humans; Internal Medicine; Medicine; Medicine & Public Health; Other Pain (A Kaye and N Vadivelu; Pain Medicine; Risk Factors; Section Editors; Topical Collection on Other Pain; Anticoagulation therapies; Evidenced-based practice; Anticoagulants; Regional anesthesia; Neuraxial anesthesia
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-019-0805-x

Purpose of Review Anticoagulant use among patients is prevalent and increasing. It is important for anesthesiologists to be aware of patients on anticoagulants while performing regional anesthesia. Recent Findings In recent years, the FDA has approved many new anticoagulants. With new drugs coming to the market, new side effect profiles should be considered when treating patients, especially when using regional anesthesia. Both ASRA and European agencies have laid out recommendations regarding anticoagulant use and neuraxial/regional techniques. Regarding newer anticoagulants, the guidelines for discontinuation prior to neuraxial injection are based on pharmacokinetics, including half-life duration for each drug. Summary While each clinical scenario requires an individualized approach, general guidelines can serve as a starting point to help with anesthetic planning and potentially improve patient safety in this evolving field.