Regional Anesthesia in the Anticoagulated Patient

Horlocker, Terese T.; Wedel, Denise J.; Benzon, Honorio T.; Brown, David L.; Enneking, Kayser F.; Heit, John A.; Mulroy, Michael F.; Rosenquist, Richard W.; Rowlingson, John C.; Tryba, M.; Yuan, Chun‐Su

doi:10.1097/00115550-200305000-00004

Cited by 57 publications

(27 citation statements)

References 119 publications

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“…Although the timing of the Wrst administration of thromboprophylaxis is controversial [17], it is recognised that bemiparin administration started 6 h after surgery does not compromise eYcacy [14], and is compatible with neuraxial anaesthesia techniques [11]. On the contrary, patients on preoperative LMWH thromboprophylaxis can be assumed to have altered coagulation.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, patients on preoperative LMWH thromboprophylaxis can be assumed to have altered coagulation. In these patients, needle placement should occur at least 10-12 h after the LMWH dose [11]. Thromboprophylaxis started less than 6 h after surgery may increase the risk of bleeding without improved eYcacy [17].…”

Section: Discussionmentioning

confidence: 99%

“…Neuraxial anaesthesia should generally be avoided in patients whose preoperative haemostasis is impaired by antithrombotic drugs [9], because of the increased risk of spinal haematoma [11,21]. In order to avoid preoperative impaired haemostasis, thus minimising the risk of spinal haematoma and intraoperative bleeding, it would be reasonable to start prophylaxis several hours after surgery, whenever the eYcacy of LMWH should not be compromised [20,24].…”

Section: Introductionmentioning

confidence: 99%

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A prospective observational study on the effectiveness and safety of bemiparin, first dose administered 6 h after knee or hip replacement surgery

Abad¹,

Gómez-Outes

Martínez

et al. 2006

Arch Orthop Trauma Surg

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Introduction Bemiparin has shown to be eVective and safe in clinical trials in total knee or hip replacement. Materials and methodsWe conducted a prospective, open, multicentre, uncontrolled study to audit the utilisation patterns of bemiparin 3,500 IU/day, Wrst dose administered 6 h after surgery, in 1,009 patients undergoing total hip or knee replacement surgery in standard clinical practice. We analysed rates of documented symptomatic venous thromboembolism (VTE) [deep-vein thrombosis (DVT) and pulmonary embolism (PE)] conWrmed by objective methods, major bleeding, death, thrombocytopaenia and other adverse events up to 6 weeks. Results Rate of documented symptomatic DVT was 0.3% (95% CI, 0.1-0.9%). No cases of documented PE were reported. There were 14 (1.4%) major bleedings (95% CI, 0.8-2.3%). Neuraxial anaesthesia was used in 937 (92.9%) patients. There were no cases of spinal haematoma, fatal bleeding or bleeding in critical organs. There were 6 (0.6%) cases of mild thrombocytopaenia, which did not require treatment discontinuation. No cases of severe type II heparin-induced thrombocytopaenia were observed. There were no deaths during bemiparin prophylaxis. The median length of hospitalisation was 9 days and 92.5% of patients continued prophylaxis post-hospitalisation for a total median time of 38 days. There were no thromboembolic or bleeding complications during post-hospitalisation prophylaxis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A prospective observational study on the effectiveness and safety of bemiparin, first dose administered 6 h after knee or hip replacement surgery

Abad¹,

Gómez-Outes

Martínez

et al. 2006

Arch Orthop Trauma Surg

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“…The likelihood of full or partial recovery in these circumstances rapidly diminishes as time to decompression approaches or exceeds 8 hours. 1 In most cases, magnetic resonance imaging (MRI) is the preferred imaging modality for spinal canal pathology, although diagnosis should not be delayed if only computed tomography (CT) is available.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Neal¹,

Bernards²,

Hadžić³

et al. 2008

Regional Anesthesia and Pain Medicine

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236

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Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine. KeywordsComplications of anesthesia; Nerve injury; Spinal anesthesia; Epidural anesthesia; Peripheral nerve block; Regional anesthesia; Pain medicine; Transforaminal block The American Society of Regional Anesthesia and Pain Medicine (ASRA) convened a group of experts to develop a Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine. The goal of this Practice Advisory is to provide information for practitioners of regional anesthesia and pain medicine regarding the etiology, differential diagnosis, prevention, and treatment of neurologic complications. This Practice Advisory focuses on neurologic injuries apart from those caused by hemorrhagic 1 or infectious2 -6 complications, both of which have been the subject of other recent ASRA-sponsored Practice Advisories. The current report is a summation of the Practice Advisory's findings and recommendations. Anesthesiologists are strongly encouraged to read the manuscripts that accompany the present summary document, because they contain the details upon which recommendations are based. The accompanying manuscripts represent most of the subtopics discussed at the conference. The recommendations contained within this Practice Advisory represent the opinions of a small group of expert panelists and are based upon their clinical experience, review of limited scientific literature (anatomic and physiologic studies of animals and human cadavers, case reports, retrospective case series, and non-randomized trials), and open forum discussion. Importantly, in this imperfect setting of controversial topics, limited data, and bias inherent to expert opinion, the Panel consistently tended towards making conservative recommendations. We acknowledge that other experts analyzing the same information may arrive at recommendations different than ours. The recommendations contained herein are not intended to define standard practice or to ensure the avoidance of adverse outcomes. Furthermore, the recommendations are subject to change as new information becomes available. Recommendations from the Practice Advisory are not intended to replace clinical judgment, and specific risk-to-benefit discussions as they pertain to individual patients.Because neurologic injuries related to anesthesia and pain medicine practice are extremely rare, standard tools of evidence-based medicine such as randomized c...

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“…Despite consensus-based recommendations for discontinuation of antiplatelet agents prior to neuraxial blockade [2], there is a paucity of evidence-based data to guide clinical practice, and continued reports such as these with documentation of platelet function will stimulate further investigation.…”

mentioning

confidence: 99%

A response to ‘Spinal anaesthesia despite combined clopidogrel and aspirin therapy in a patient awaiting lung transplantation: effects of platelet transfusion on clotting tests’

Pivalizza¹,

Gottschalk²

2005

Anaesthesia

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Regional Anesthesia in the Anticoagulated Patient

Cited by 57 publications

References 119 publications

A prospective observational study on the effectiveness and safety of bemiparin, first dose administered 6 h after knee or hip replacement surgery

A prospective observational study on the effectiveness and safety of bemiparin, first dose administered 6 h after knee or hip replacement surgery

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

A response to ‘Spinal anaesthesia despite combined clopidogrel and aspirin therapy in a patient awaiting lung transplantation: effects of platelet transfusion on clotting tests’

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