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Antithrombotics and regional anaesthesia

T J Martin, R K Kerridge
No abstract text is available yet for this article.
May 1, 2017: British Journal of Anaesthesia
C M Kumar, E Seet
No abstract text is available yet for this article.
February 2017: British Journal of Anaesthesia
Gennaro Scibelli, Lucia Maio, Gennaro Savoia
BACKGROUND: The use of anticoagulant agents represents a serious limitation of regional anesthesia, due to the risk of spinal hematoma. Examining all the principles currently available, it has been possible to notice that published guidelines are very often incomplete or also differ significantly on the rules to be followed relating to a specific drug. METHODS: We have carried out a comparison between the guidelines of major scientific societies in order to take a practical and simple user guide which operators can consult...
March 2017: Minerva Anestesiologica
R I Baker, S R McGreor
No abstract text is available yet for this article.
September 2014: Anaesthesia and Intensive Care
T T Horlocker
The actual incidence of neurological dysfunction resulting from haemorrhagic complications associated with neuraxial block is unknown. Although the incidence cited in the literature is estimated to be <1 in 150,000 epidural and <1 in 220,000 spinal anaesthetics, recent surveys suggest that the frequency is increasing and may be as high as 1 in 3000 in some patient populations. Overall, the risk of clinically significant bleeding increases with age, associated abnormalities of the spinal cord or vertebral column, the presence of an underlying coagulopathy, difficulty during needle placement, and an indwelling neuraxial catheter during sustained anticoagulation (particularly with standard unfractionated heparin or low molecular weight heparin)...
December 2011: British Journal of Anaesthesia
J S Englbrecht, E M Pogatzki-Zahn, P Zahn
Neuraxial anesthesia is an established and safe procedure in perioperative pain therapy which can help to minimize complications and to improve perioperative outcome. In patients with acquired bleeding disorders by comorbidities or concomitant antithrombotic medication an individual decision should be made based on risks and benefits. A large number of literature references and guidelines help making a decision, for example the recently updated evidence-based guidelines of the American Society of Regional Anesthesia and Pain Medicine for patients receiving antithrombotic or thrombolytic therapy...
December 2011: Der Anaesthesist
F Randelli, F Biggi, G Della Rocca, P Grossi, D Imberti, R Landolfi, G Palareti, D Prisco
Anticoagulant prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures (FNF). Different guidelines are available in the literature, with quite different recommendations. None of them is a multidisciplinary effort as the one presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the association of Orthopaedists and Traumatologists of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) have set down easy and quick suggestions for VTE prophylaxis in hip and knee surgery as well as in FNF treatment...
March 2011: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
Wiebke Gogarten, Erik Vandermeulen, Hugo Van Aken, Sibylle Kozek, Juan V Llau, Charles M Samama
BACKGROUND AND OBJECTIVES: performing neuraxial anaesthesia in patients receiving antithrombotic drugs is controversial due to the increased risk of spinal epidural haematoma. Strict adherence to the recommended time intervals between the administration of anticoagulants, neuraxial blockade and the removal of catheters is thought to improve patient safety and reduce the risk of haematoma. Appropriate guidelines have been prepared by a number of national societies of anaesthesiologists, but they do not have universal acceptance...
December 2010: European Journal of Anaesthesiology
Erik Vandermeulen
As the life expectancy of our Western population progressively increases, so does the prevalence of cardiovascular disease and thus the use of antithrombotic drugs. The use of central neuraxial anaesthesia techniques in patients treated with these drugs is a major clinical problem as the presence of an impaired coagulation has been found to be the most important risk factor contributing to the formation of a spinal haematoma. The growing number of case reports of spinal haematoma has led many national societies of anaesthetists to come up with guidelines...
March 2010: Best Practice & Research. Clinical Anaesthesiology
Javier Granero Xiberta, José María Soler Minoves, Laura Garcia Nuño
Thromboembolic complications are frequent after orthopaedic surgery of the limbs. Strategies to minimize these complications go from recognize the risk factors of the patient to introduce new antithrombotic drugs, and including general medical care, regional anaesthesia and early mobilization. Based in epidemiological studies, prophylaxis must be extended 4-6 weeks in total hip and knee arthroplasty and in surgery of the hip fracture.
November 2008: Medicina Clínica
N Rosencher, M-P Bonnet, D I Sessler
We propose recommendations to reduce the risk of haemorrhagic events associated with regional anaesthesia in patients treated with newer anticoagulants after orthopaedic surgery. The risk/benefit ratio should be individualised for each patient according to the type and dose of anticoagulant, the type of regional anaesthesia and patient risk factors. Neuraxial anaesthetic management strategy can be based on the pharmacokinetic properties of specific anticoagulants, including the time required to reach maximal concentration, half-life, and dose regimen...
November 2007: Anaesthesia
Erik Vandermeulen
PURPOSE OF REVIEW: New anticoagulant drugs are introduced by the pharmaceutical industry on a regular basis. Anaesthesiologists are not always very familiar with these drugs although their use may augment perioperative bleeding and increase the likelihood of a compressing spinal haematoma when combined with epidural or spinal anaesthetic techniques. This review discusses the latest of these new anticoagulants and their consequences for anaesthesiological practice. RECENT FINDINGS: Durning the last few years, selective factor Xa inhibitors, glycoprotein IIb/IIIa receptor antagonists and direct thrombin inhibitors have been introduced into clinical practice...
June 2005: Current Opinion in Anaesthesiology
P Roderick, G Ferris, K Wilson, H Halls, D Jackson, R Collins, C Baigent
OBJECTIVES: To assess the benefits in terms of reductions in the risks of deep vein thrombosis (DVT) and of pulmonary embolism (PE), and hazards in terms of major bleeding, of: (i) mechanical compression; (ii) oral anticoagulants; (iii) dextran; and (iv) regional anaesthesia (as an alternative to general anaesthesia) in surgical and medical patients. DATA SOURCES: Electronic databases, search of Antithrombotic Trialists' Collaboration database, contact with trialists and manufacturers...
December 2005: Health Technology Assessment: HTA
Sibylle A Kozek-Langenecker
Platelet dysfunctions are known origins of perioperative bleeding disorders which are a major concern in the management of surgical patients. Among multiple factors, interactions of drugs used in anaesthesia with platelets have been implicated to aggravate the risk of haemorrhagic complications. This paper reviews in vitro and in vivo studies which have examined the effects of inhalational, intravenous, and local anaesthetics, opioids, and muscle relaxants on platelets. A brief summary of platelet physiology, function tests, and flow cytometric assessment of membrane receptors is included...
June 2002: Current Drug Targets
L Konradsen, L N Jørgensen, E Albrecht-Beste, S P Nielsen
In 79 patients undergoing hip or knee replacement surgery the preoperative condition of the popliteal vein valves was assessed by Doppler ultrasonography. Presence of postoperative deep vein thrombosis was determined by bilateral ascending phlebography seven to ten days after surgery. Antithrombotic prophylaxis consisted solely of TED stockings and early mobilization. The overall incidence of deep vein thrombosis was 20%. All thrombi were calf vein thrombi. One of these thrombi extended into the popliteal region and two into the femoral region...
June 1990: Acta Chirurgica Scandinavica
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