The influence of new antithrombotic drugs on regional anesthesia

Curr Opin Anaesthesiol. 2006 Oct;19(5):545-50. doi: 10.1097/


Purpose of review: Antithrombotic drugs are known to increase the risk of spinal epidural hematoma after neuraxial blockade. During the last few years, several new anticoagulants have been introduced, some of them more potent than the drugs currently available. More potency, however, may also indicate a higher risk of bleeding.

Recent findings: Case series from the last few years indicate that spinal epidural hematoma is more common then previously estimated, with a prevalence from 1: 100,000 in obstetric patients to as high as 1: 3,600 in female orthopedic patients. In order to diminish this risk, most national societies have issued guidelines in which time intervals were established between administration of antithrombotic drugs and performance of neuraxial blockade.

Summary: Guidelines are perceived to be capable of reducing the incidence of spinal epidural hematoma with the inherent risk of permanent paraplegia. These guidelines, however, will only be a valuable aid for clinicians if they are constantly updated and newer antithrombotic drugs are included. Although the resurge of peripheral nerve blocks may diminish patient hazards, deep nerve blocks such as lumbar sympathetic blockade are not devoid of serious complications and should probably be handled in the same way as neuraxial blockade.

Publication types

  • Review

MeSH terms

  • Adenosine Diphosphate / antagonists & inhibitors
  • Anesthesia, Conduction / adverse effects*
  • Anesthesia, Epidural / adverse effects
  • Aspirin / adverse effects
  • Cardiac Surgical Procedures
  • Clinical Trials as Topic
  • Drug Administration Schedule
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / adverse effects*
  • Fondaparinux
  • Hematoma, Epidural, Spinal / chemically induced
  • Hematoma, Epidural, Spinal / epidemiology
  • Hematoma, Epidural, Spinal / etiology*
  • Heparin, Low-Molecular-Weight / adverse effects
  • Humans
  • Nerve Block / adverse effects
  • Pain Measurement
  • Pain, Postoperative / prevention & control
  • Plant Preparations / adverse effects
  • Platelet Aggregation Inhibitors / adverse effects
  • Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
  • Polysaccharides / adverse effects
  • Practice Guidelines as Topic
  • Prevalence
  • Risk Assessment
  • Risk Factors


  • Fibrinolytic Agents
  • Heparin, Low-Molecular-Weight
  • Plant Preparations
  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Polysaccharides
  • Adenosine Diphosphate
  • Fondaparinux
  • Aspirin