ASRA guidelines were developed to stratify interventional spine and pain procedures by bleeding risk for patients on antiplatelet and anticoagulant medications, though large study data is lacking.
What are the appropriate guidelines for managing antiplatelet and anticoagulant medications in patients undergoing interventional spine and pain procedures?
This document provides ASRA guidelines for managing antiplatelet and anticoagulant medications in patients undergoing interventional spine and pain procedures, stratified by bleeding risk.
Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine. The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.
Narouze et al. (2015) conducted a review in Patients on antiplatelet and anticoagulant medications undergoing interventional spine and pain procedures. ASRA guidelines for interventional spine and pain procedures was evaluated. ASRA guidelines were developed to stratify interventional spine and pain procedures by bleeding risk for patients on antiplatelet and anticoagulant medications, though large study data is lacking.