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Central neuraxial blocks and anticoagulation: a review of current trends

Published online by Cambridge University Press:  16 August 2006

A. Tyagi
Affiliation:
University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahadra, Delhi, India
A. Bhattacharya
Affiliation:
University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahadra, Delhi, India
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Abstract

Patients receiving anticoagulants offer a challenge to anaesthesiologists. The issue of spinal haematoma following central neuraxial block in such patients is a contentious issue. Although rare, with an estimated incidence of <1 : 150 000 for epidural blocks and 1 : 220 000 for spinal anaesthetics in patients with normal coagulation status, this is an emergency situation with a potentially grave prognosis. The review presents cases of spinal haematomata that have occurred in the last 5 years, both spontaneously and after central neuraxial blockade. Of the 60 cases reported in the literature, 33% occurred following central neuraxial block and, of these, 55% were associated with concomitant use of anticoagulants. The pharmacology of the newer and older anticoagulants is also described. The variety of risk factors and diverse recommendations that have been described in these patients are reviewed.

Type
Review
Copyright
2002 European Society of Anaesthesiology

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