Periprocedural management of patients on oral anticoagulation: focus on regional anesthesia

The management of anticoagulant medications in patients undergoing regional anesthesia procedures remains an evolving topic. As with all procedures, the goal is to maintain balance between bleeding and thrombotic risks when interrupting oral anticoagulants. In contrast with operating room procedures, in which the blood loss volume is probably the most important concern, for regional anesthesia procedures, it is the location of the bleeding event that takes precedence. For neuraxial anesthesia and deep plexus and peripheral nerve blocks, a lower volume bleed in an enclosed deep noncompressible area can result in transient or permanent neuronal damage. Differences exist between current guidelines for the management of oral anticoagulants, likely due to patient anatomy, practitioner experience, and standardized use of imaging modalities for different procedures.