Review article
https://doi.org/10.20471/acc.2022.61.s2.08
Peripheral Nerve Blocks in Patients on Antithrombotic Drugs – a Rescue or an Unnecessary Risk?
Peter Poredoš
orcid.org/0000-0001-5258-443X
; Department of Anesthesiology and Surgical Intensive Care, University Medical Center Ljubljana, Slovenia
Abstract
Bleeding complications after peripheral nerve blocks (PNBs) in patients treated
with an antiplatelet agent and/or an anticoagulant drug are rare, with estimated incidence of 0.67%
(0.51–0.83%). However, they can result in significant patient morbidity and may require follow-up
investigations and interventions. The evidence for bleeding risks and complications after PNB is very
low or nonexistent, therefore, recommendations and guidelines are based on retrospective analyses,
case reports, expert opinions and expert panel consensus. In the manuscript, an expert panel consensus
on classification of PNBs according to the potential risk of serious bleeding complications is presented.
The risks of bleeding depend on the location (vicinity of the vessels and critical structures at
risk from the mass effect of a hematoma), block depth (which influences needle visibility), associated
comorbidities and anticoagulation status, body habitus, site compressibility, whether the bleeding or
hematoma are easy or not to assess and how easy or not an intervention may be applied to prevent or
treat bleeding. Also, technical factors are considered: type and size of the used needle, technical difficulties,
multiple attempts, needle passes and bloody tap, use of catheters and type of nerve location
technique (USG versus blind techniques) and operator experience.
In all patients on antithrombotic drugs, benefits vs. risks should be weighted. A bleeding risk
should be minimized with the optimization of patient’s coagulation: appropriate antithrombotic drug
timing before PNB, dose of antithrombotic drug, indication for the drug and risk factors that may
influence drug pharmacokinetics (bodyweight, age, renal and hepatic function). Superficial PNBs may
be performed in the presence of antithrombotic drug. For deep PNBs, a recommendations for neuraxial
procedures should be considered.
Keywords
Peripheral nerve block; Anticoagulants; Platelet inhibitors; Bleeding complications; Regional anesthesia
Hrčak ID:
284302
URI
Publication date:
1.9.2022.
Visits: 1.589 *