Regional anesthesia in the anticoagulated patient: Defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation)

Neuraxial anesthesia and analgesia provide several advantages over systemic opioids, including superior analgesia, reduced blood loss and need for transfusion, decreased incidence of graft occlusion, and improved joint mobility following major knee surgery. 1-4 New challenges in the management of patients undergoing neuraxial block have arisen over the last 2 decades, as medical standards for the prevention of perioperative venous thromboembolism were established. 5,6 Concern for patient safety in the presence of potent antithrombotic drugs has resulted in avoidance of regional anesthesia. Indeed, perioperative anesthesia and analgesia are often determined by the antithrombotic agent. 7 Conversely, although the anesthesia community is well aware of the potential for spinal bleeding, other specialties have only recently become cognizant of the risk, as documented by case reports