Revista Brasileira de Anestesiologia
Print version ISSN 0034-7094
YAMASHITA, Américo Massafuni and YASSUDA, Heitor. Thromboprophilaxis and neuraxial blockade. Rev. Bras. Anestesiol. [online]. 2001, vol.51, n.4, pp. 350-366. ISSN 0034-7094. http://dx.doi.org/10.1590/S0034-70942001000400012.
BACKGROUND AND OBJECTIVES: Among peripheral vascular diseases, thromboembolytic venous disease has gained significant importance due to its high frequency, morbidity and mortality, and, moreover, due to the possibility of interrupting its evolution when there is an adequate diagnosis and treatment. The increasing use of thromboprophylaxis has become a problem for anesthesiologists since those agents have increased the incidence of spinal hematoma when associated to regional anesthesia. After a broad literature review, this study aimed at presenting to anesthesiologists the biochemistry and pharmacology of most commonly used anticoagulants as well as recommendations for regional blockade in patients under anticoagulants. CONTENTS: Characteristics of different anticoagulants and regional anesthesia implications are presented. After each drug description there are considerations about the most important recommendations. CONCLUSIONS: Regional anesthesia under thromboprophylaxis demands lots of caution, especially as to the use of epidural catheters and repeated and traumatic punctures because, in those cases, there is an increased risk for spinal hematomas. In addition, communication between the clinical and nursing staff involved in the management of patients receiving anticoagulants is essential in order to decrease the risk for severe hemorrhagic complications. Patients should be closely monitored for early signs of cord compression. If spinal hematoma is suspected, radiographic confirmation must be immediately sought due to the risk for irreversible cord ischemia.
Keywords : ANESTHETIC TECHNIQUES, Regional [epidural, spinal block]; ANTICOAGULANTS.