Anticoagulation and Neuraxial/Peripheral Anesthesia

Anesthesiol Clin. 2017 Jun;35(2):e21-e39. doi: 10.1016/j.anclin.2017.01.002.

Abstract

Novel anticoagulants (NAGs) have emerged as the preferred alternatives to vitamin K antagonists. In patients being considered for regional anesthesia, these drugs present a layer of complexity in the preprocedure evaluation. There are no established tests to monitor anticoagulant activity and our experience is short with these drugs. These authors believe it is important to review the relevant hematology, orthopedics, and anesthesiology literature to provide a valuable reference for the clinician who is met with these challenges. In addition to discussing NAGs, we also review the existing American Society of Regional Anesthesia guidelines for heparin, low-molecular-weight heparin, and antiplatelet agents.

Keywords: Anticoagulation; Antiplatelet; Coumadin; Direct thrombin inhibitors; Factor Xa inhibitors; Neuraxial; Regional.

Publication types

  • Review

MeSH terms

  • Anesthesia, Conduction / methods*
  • Anticoagulants / adverse effects*
  • Anticoagulants / pharmacokinetics
  • Fibrinolytic Agents / adverse effects
  • Fibrinolytic Agents / pharmacokinetics
  • Heparin / adverse effects
  • Heparin / pharmacokinetics
  • Heparin, Low-Molecular-Weight / adverse effects
  • Humans
  • Platelet Aggregation Inhibitors / adverse effects
  • Practice Guidelines as Topic
  • Vitamin K / antagonists & inhibitors

Substances

  • Anticoagulants
  • Fibrinolytic Agents
  • Heparin, Low-Molecular-Weight
  • Platelet Aggregation Inhibitors
  • Vitamin K
  • Heparin