Regional anesthesia in the anticoagulated patient: Defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation)

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

doi:10.1053/rapm.2003.50046

Cited by 547 publications

(541 citation statements)

References 150 publications

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“…La planificación cuidadosa con el cirujano y la adhesión a la directrices de la ASRA (American Society of Regional Anesthesia and Pain) 92 para la anestesia/analgesia neuroaxial en la presencia de estos medicamentos ayudarán a minimizar los riesgos.…”

Section: Analgesia Epiduralunclassified

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

Morales-Muñoz

Sánchez-Ramos

Díaz-Lara

et al. 2017

Revista Española de Anestesiología y Reanimación

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Section: Analgesia Epiduralunclassified

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

Morales-Muñoz

Sánchez-Ramos

Díaz-Lara

et al. 2017

Revista Española de Anestesiología y Reanimación

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“…Spinal hematoma, defined as symptomatic intraspinal bleeding, 7 can occur spontaneously, following trauma or as a rare complication of intradural and epidural anesthesia. Spontaneous spinal hematoma is seen in association with anticoagulant treatment, disorders of coagulation, vascular malformations in the spinal canal and intraspinal tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Apparent risk factors for developing spinal hematoma following neuraxial anesthesia are female gender, old age, traumatic procedure, history of gastrointestinal bleeding, patients receiving anticoagulation and commencement of anticoagulation shortly after the spinal injection. 7,9 The risk of bleeding following epidural injection in persons receiving anticoagulation has been an issue of considerable debate. In a review of the literature, Vandermeulen et al 10 found 68% of all spinal hematoma following neuraxial anesthesia to be associated with hemostatic abnormality.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous complete recovery of paraplegia caused by epidural hematoma complicating epidural anesthesia: a case report and review of literature

2005

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Study design: Case report. Setting: Tertiary referral spinal surgery center in South India. Objectives: To report a patient who developed epidural hematoma following epidural anesthesia causing acute paraplegia. Surgery was avoided due to concomitant gastrointestinal bleeding and poor general condition. Patient showed early signs of recovery with complete resolution of neurological deficits in 12 weeks. Conclusion: Surgery can be avoided in patients who show early signs of neurological recovery following epidural hematoma.

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“…In view of this risk the American Society of Regional Anesthesia (ASRA) proposed that clopidogrel should be discontinued for 7 days before spinal anesthesia 27 . On the other hand, it is well known that clopidogrel discontinuation may be associated with increased risk of ischemic events in high-risk patients 16,17,18 .…”

Section: Thienopyridinesmentioning

confidence: 99%

Lumbar puncture in patients using anticoagulants and antiplatelet agents

Domingues¹,

Bruniera

Brunale

et al. 2016

Arq. Neuro-Psiquiatr.

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The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks.

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Regional anesthesia in the anticoagulated patient: Defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation)

Abstract: 2016-12-26T15:02:54

Cited by 547 publications

References 150 publications

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

Spontaneous complete recovery of paraplegia caused by epidural hematoma complicating epidural anesthesia: a case report and review of literature

Lumbar puncture in patients using anticoagulants and antiplatelet agents

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