Modern anaesthetic techniques and anticoagulation

Summary The many possibilities for anticoagulant pharmacotherapy are constantly increasing. Anaesthetists and pain therapists are confronted with patients being treated with highly effective anticoagulants and/or platelet aggregation inhibitors for coronary heart disease, stroke or peripheral arterial occlusive disease. These patients in particular benefit from neuraxial blockade when undergoing cardiac surgery, revascularisation procedures or amputation. The anaesthetist needs to be familiar with the pharmacology, indications, and adverse effects of the various anti- and procoagulant substances, and to integrate this knowledge into the management concept to prevent haemorrhagic complications. This review presents the basics of coagulation, sites of action of currently-used anticoagulants, and the Austrian standards for performing modern central and peripheral nerve blocks in patients on antithrombotic medication. Preoperative assessment of existing anticoagulant therapy is also very important in general anaesthesia, as this can be used to determine the appropriate procedures for perioperative coagulation management. In order to prevent bleeding complications in patients on antithrombotic therapy, the following questions are addressed and appropriate recommendations given: intervals between administering anticoagulant agents and puncture/removal of catheters or a general anaesthesia and surgery; the choice of local or regional anaesthetic method and of intraoperative coagulation analysis; reversal of anticoagulation in acute situations.