Use of neuraxial anesthesia with selective factor Xa inhibitors.

It has become increasingly well documented that, compared with general anesthesia, neuraxial anesthesia reduces the risk of venous thromboembolism after joint replacement surgery. The concurrent use of anticoagulants with neuraxial anesthesia, however, has raised some safety concerns. Recent large-scale, prospective, randomized experience indicates that the selective factor Xa inhibitor fondaparinux does not increase the risk of epidural hematoma when used in combination with neuraxial anesthesia.