Anaesthesia and new antithrombotic drugs.

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. These drugs are typically more reliable and efficacious, have a lower incidence of side effects, are easier to use and will not need routine monitoring of their anticoagulant effects. In addition, their superior efficacy often implies a more profound anticoagulant action while reversing agents are mostly lacking and clinical experience is limited.

SUMMARY: There is currently not enough information available to make any firm statements about the safety of combining regional anaesthesia and the new anticoagulant agents. Until such information becomes available, knowledge of the pharmacological profile of these drugs in terms of elimination half-life, the potential for thrombocytopenia and the availability of antagonizing drugs will help us to decide whether or not a major regional anaesthetic technique will be feasible in the individual patient treated with these new compounds.