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Minerva Anestesiologica 2017 March;83(3):321-35

DOI: 10.23736/S0375-9393.16.11414-2


language: English

Regional anesthesia and antithrombotic agents: instructions for use

Gennaro SCIBELLI 1, Lucia MAIO 1, Gennaro SAVOIA 2

1 Department of Anesthesia and Intensive Care, ASL Caserta, Caserta, Italy; 2 Department of Anesthesia and Intensive Care, AORN A. Cardarelli, Naples, Italy
A correction to this article is available online at https://www.doi.org/10.23736/S0375-9393.20.14494-8


The use of anticoagulant agents represents a serious limitation of regional anesthesia, due to the risk of spinal hematoma. Examining all the principles currently available, it has been possible to notice that published guidelines are very often incomplete or also differ significantly on the rules to be followed relating to a specific drug. A comparison was carried out between the guidelines of major scientific societies in order to take a practical and simple user guide which operators can consult. The more and more frequent occurrence of patients who undergo dual antiplatelet and need to be subjected to surgery was taken into account, considering regional anesthesia as a possible alternative to general anesthesia in conditions of election and not deferrable urgency. We describe the main anticoagulant drugs used in therapy. Regarding the low-molecular-weight heparins, we have reported the most important properties, highlighting the substantial differences of their use detectable by comparison between American and European Guidelines. A similar comparison has been made for the main antiplatelet drugs, including aspirin, and thrombin inhibitors. A particular chapter is dedicated to new oral anticoagulant drugs, especially for the low possibility of allowing regional anesthesia. The comparison between the main guidelines often highlights substantial disparities and weak evidences, so operators must carry out a careful risk-benefit analysis prior to regional anesthesia.

KEY WORDS: Local anesthesia - Spinal epidural hematoma - Fibrinolytic agents

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