Anticlotting drugs and regional anaesthetic and analgesic techniques

Abstract

The wide use of anticlotting drugs by patients scheduled for surgery is a challenge for the anaesthesiologist when considering a regional anaesthesia technique. This practice seems safe if there is an appropriate management based on safety intervals established according to the pharmacology of the drug and the regional technique. Some anaesthesiology societies have published recommendations for the safe practice of regional anaesthesia with the simultaneous use of anticoagulants (heparin, low molecular weight heparins, oral anticoagulants (OA), fondaparinux and others) and antiplatelet agents (aspirin, clopidogrel, ticlopidine, argatroban and others). One of the most recent guidelines has been published by the Spanish Society of Anaesthesia and Critical Care. This article reviews these recommendations and compares them with others published in the last years. The recommendations are similar, but some interesting differences can be observed and need to be considered. A European consensus in this setting would probably be necessary.

Contraindications - Hemorrhage and Coagulopathy, and Patient Refusal

“…In this context, there are a large number of recommendations approved by scientific anesthesia societies (Horlocker et al, 2003;Vandermeulen et al, 2005;Samama et al, 2002). This enabled comparison of similarities and differences in some important situations (Llau et al, 2007).…”

“…(Donegan et al, 2007). The risk of developing epidural hematoma is reduced if care is taken for the characteristics of these drugs and the safe time intervals needed for administering the regional technique (Llau et al, 2001). Neuraxial anesthesia can be accepted in these patients only if coagulation is optimized and monitoring is done during the application.…”

“…Unfractional heparin (UH) is administered subcutaneously (sc) or intravenously (iv). Its half-life varies according to the dose (Llau et al, 2007).…”

“…Having a break for 7 days will increase the risk of developing cardiovascular and neurologic complication (Burger et al, 2005). It is recommended that antiaggregants, ASA in particular, should be restarted between postoperative 6 and 24 h (Llau et al, 2007).…”

“…Today, it is not recommended to administer a regional technique to patients who are under the influence of ticlopidine or clopidogrel. Nevertheless, a regional technique can safely be administered after suspending the clopidogrel therapy for 7 days and the ticlopidine therapy for 10 days (Llau et al, 2007).…”