Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, United States.
Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, United States
Pol Arch Intern Med. 2020 Dec 22;130(12):1081-1092. doi: 10.20452/pamw.15416. Epub 2020 Jun 3.
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.
在接受区域麻醉程序的患者中，抗凝药物的管理仍然是一个不断发展的话题。与所有程序一样，目标是在中断口服抗凝剂时在出血和血栓形成风险之间保持平衡。与手术室程序不同，在手术室程序中，出血量可能是最重要的关注点，而对于区域麻醉程序，出血部位是首要考虑的问题。对于神经轴麻醉以及深部丛和周围神经阻滞，在封闭的深部非可压缩区域中出血量较少可能导致暂时性或永久性神经元损伤。目前口服抗凝剂管理指南之间存在差异，这可能是由于患者解剖结构、医生经验以及不同程序中对成像方式的标准化使用所致。
