Regional anaesthesia in patients on antithrombotic drugs: Joint ESAIC/ESRA guidelines.

Fecha de publicación: 01/02/2022

Autores de IIS La Fe

Raquel Ferrandis Comes

Autor

Participantes ajenos a IIS La Fe

Kietaibl, Sibylle
Godier, Anne
Llau, Juan
Lobo, Clara
Macfarlane, Alan J. R.
Schlimp, Christoph J.
Vandermeulen, Erik
Volk, Thomas
von Heymann, Christian
Wolmarans, Morne
Afshari, Arash

Grupos

Medicina Perioperatoria, Anestesiología y Reanimación

Leader

Óscar Díaz Cambronero

Abstract

BACKGROUND: Bleeding is a potential complication after neuraxial and peripheral nerve blocks. The risk is increased in patients on antiplatelet and anticoagulant drugs. This joint guideline from the European Society of Anaesthesiology and Intensive Care and the European Society of Regional Anaesthesia aims to provide an evidence-based set of recommendations and suggestions on how to reduce the risk of antithrombotic drug-induced haematoma formation related to the practice of regional anaesthesia and analgesia. DESIGN: A systematic literature search was performed, examining seven drug comparators and 10 types of clinical intervention with the outcome being peripheral and neuraxial haematoma. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the methodological quality of the included studies and for formulating recommendations. A Delphi process was used to prepare a clinical practice guideline. RESULTS: Clinical studies were limited in number and quality and the certainty of evidence was assessed to be GRADE C throughout. Forty clinical practice statements were formulated. Using the Delphi-process, strong consensus (>90% agreement) was achieved in 57.5% of recommendations and consensus (75 to 90% agreement) in 42.5%. DISCUSSION: Specific time intervals should be observed concerning the adminstration of antithrombotic drugs both prior to, and after, neuraxial procedures or those peripheral nerve blocks with higher bleeding risk (deep, noncompressible). These time intervals vary according to the type and dose of anticoagulant drugs, renal function and whether a traumatic puncture has occured. Drug measurements may be used to guide certain time intervals, whilst specific reversal for vitamin K antagonists and dabigatran may also influence these. Ultrasound guidance, drug combinations and bleeding risk scores do not modify the time intervals. In peripheral nerve blocks with low bleeding risk (superficial, compressible), these time intervals do not apply. CONCLUSION: In patients taking antiplatelet or anticoagulant medications, practitioners must consider the bleeding risk both before and after nerve blockade and during insertion or removal of a catheter. Healthcare teams managing such patients must be aware of the risk and be competent in detecting and managing any possible haematomas.

Datos de la publicación

ISSN/ISSNe:: 0265-0215, 1365-2346
Tipo:: Article
Páginas:: 100-132
DOI:: 10.1097/EJA.0000000000001600
Factor de Impacto:: 0,979 SCImago ℠
Cuartil:: Q1 SCImago ℠

Documentos

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Métricas

Filiaciones

Kietaibl, Sibylle:: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria (CJS), Department of Anaesthesia, University Hospitals Leuven. Catholic University of Leuven, Leuven, Belgium (EV), Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar (TV), Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes K

Evangel Hosp Vienna, Dept Anaesthesia & Intens Care, Hans Sachs Gasse 10-12, A-1180 Vienna, Austria

Sigmund Freud Private Univ, Vienna, Austria
Ferrandis, Raquel:: Hosp Univ & Politecn La Fe, Dept Anaesthesiol & Crit Care, Valencia, Spain
Godier, Anne:: Hop Europeen Georges Pompidou, AP HP, Dept Anaesthesiol & Crit Care, Paris, France

Univ Paris, INSERM, UMRS 1140, Paris, France
Llau, Juan:: Doctor Peset Univ Hosp, Dept Anaesthesiol & Crit Care, Valencia, Spain

Univ Valencia, Dept Surg, Valencia, Spain
Lobo, Clara:: Hosp Forcas Armadas, Serv Anestesiol, Porto, Portugal
Macfarlane, Alan J. R.:: Univ Glasgow, Glasgow Royal Infirm, Dept Anaesthesia Pain Med & Crit Care, Glasgow, Lanark, Scotland
Schlimp, Christoph J.:: AUVA Trauma Ctr Linz, Dept Anaesthesia & Intens Care Med, Linz, Austria

AUVA Trauma Res Ctr, Ludwig Boltzmann Inst Expt & Clin Traumatol, Vienna, Austria
Vandermeulen, Erik:: Katholieke Univ Leuven, Univ Hosp Leuven, Dept Anaesthesia, Leuven, Belgium
Volk, Thomas:: Saarland Univ Med Ctr, Dept Anaesthesiol Intens Care & Pain Therapy, Homburg, Germany

Saarland Univ, Fac Med, Homburg, Germany
von Heymann, Christian:: Vivantes Klinikum Friedrichshain, Dept Anaesthesia Intens Care Med Emergency Med &, Berlin, Germany
Wolmarans, Morne:: Norfolk & Norwich Univ Hosp NHS Trust, Dept Anaesthesia, Norwich, Norfolk, England
Afshari, Arash:: Univ Copenhagen, Rigshosp, Juliane Marie Ctr, Dept Pediat & Obstet Anesthesia, Copenhagen, Denmark

Keywords

MOLECULAR-WEIGHT HEPARIN; DIRECT ORAL ANTICOAGULANTS; EPIDURAL CATHETER REMOVAL; DUAL ANTIPLATELET THERAPY; MAJOR ORTHOPEDIC-SURGERY; PERIPHERAL-NERVE BLOCKS; PATIENTS RECEIVING THROMBOPROPHYLAXIS; PROTHROMBIN COMPLEX CONCENTRATE; PARTIAL THROMBOPLASTIN TIME; CORONARY-ARTERY-DISEASE