RSS-Feed abonnieren
DOI: 10.1055/s-0037-1617081
Modern anaesthetic techniques and anticoagulation
Publikationsverlauf
Publikationsdatum:
23. Dezember 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034925/2006S02/lookinside/thumbnails/10-1055-s-0037-1617081-1.jpg)
Summary
The many possibilities for anticoagulant pharmacotherapy are constantly increasing. Anaesthetists and pain therapists are confronted with patients being treated with highly effective anticoagulants and/or platelet aggregation inhibitors for coronary heart disease, stroke or peripheral arterial occlusive disease. These patients in particular benefit from neuraxial blockade when undergoing cardiac surgery, revascularisation procedures or amputation. The anaesthetist needs to be familiar with the pharmacology, indications, and adverse effects of the various anti- and procoagulant substances, and to integrate this knowledge into the management concept to prevent haemorrhagic complications.
This review presents the basics of coagulation, sites of action of currently-used anticoagulants, and the Austrian standards for performing modern central and peripheral nerve blocks in patients on antithrombotic medication. Preoperative assessment of existing anticoagulant therapy is also very important in general anaesthesia, as this can be used to determine the appropriate procedures for perioperative coagulation management. In order to prevent bleeding complications in patients on antithrombotic therapy, the following questions are addressed and appropriate recommendations given: intervals between administering anticoagulant agents and puncture/removal of catheters or a general anaesthesia and surgery; the choice of local or regional anaesthetic method and of intraoperative coagulation analysis; reversal of anticoagulation in acute situations.
-
References
- 1 Beck K, Mohr P, Bleckmann U. et al. Desmopressin effect on acetylsalicylic acid impaired platelet function. Semin Thromb Hemost 1995; 21: 32-9.
- 2 Chun R, Orser B, Madan M. Platelet glycoprotein IIb/IIIa inhibitors: Overview and implications for the anesthesiologist. Anesth Analg 2002; 95: 879-888.
- 3 Cook D, Meade M, Guyatt G. et al. Clinically important deep vein thrombosis in the intensive care unit: a survey of intensivists. Crit Care 2004; 8: R145-R152.
- 4 Delis K, Knaggs A, Mason P. et al. Effects of epidural-and general anesthesia combined versus general anesthesia alone on the venous hemodynamics of the lower limb: A randomized study. Thromb Haemost 2004; 92: 1003-1011.
- 5 Dempfle C. Perioperative coagulation diagnostics. Anaesthesist 2005; 54: 167-75.
- 6 Dzik W. Prediciting hemorrhage using preoperative coagulation screening assays. Current Hematology Reports 2004; 3: 324-330.
- 7 Geerts W, Pineo G, Heit J. et al. Prevention of venous thromboembolism: the seventh ACCP Conference of antithrombotic and thrombolytic therapy. Chest 2004; 126: 338-400.
- 8 Gogarten W, van Aken H, Büttner J. et al. Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe / antithrombotische Medikation. Anästh Intensivmedizin 2003; 44: 218-230.
- 9 Heres E, Horrow J, Gravlee G. et al. A dose-determining trial of heparinase-I (Neutralase) for heparin neutralization in coronary artery surgery. Anesth Analg 2001; 93: 1446-1452.
- 10 Jackson R. Case of spinal apoplexy. Lancet 1869; 2: 538-539.
- 11 Kakkar V, Cohen A, Edmonson R. et al. Low molecular weight versus standard heparin for prevention of thromboembolism after major abdominal surgery. The Thromboprophylaxis Collaborative Group. Lancet 1993; 341: 259-265.
- 12 Kam P, Nethery C. The Thienopyridine derivates (platelet adenosine diphosphate receptor antagonists), pharmacology and clinical developments. Anaesthesia 2003; 58: 28-35.
- 13 Koscielny J, Ziemer S, Radtke H. et al. A practical concept for preoperative identification of patients with impaired primary hemostasis. Clin Appl Thromb Hemost 2004; 10: 195-204.
- 14 Kovesi T, Royston D. Is there a problem with platelet active drugs?. Br J Anaesth 2002; 88: 159-163.
- 15 Kozek-Langenecker S. The effect of drugs used in anaesthesia on platelet membrane receptors and on platelet function. Current Drug Targets 2002; 3: 247-258.
- 16 Kozek-Langenecker S. Effects of hydroxyethyl starch solutions on hemostasis. Anesthesiology 2005; 103: 654-660.
- 17 Kozek-Langenecker S. Lokoregionalanästhesie und Blutgerinnung: Behandlung mit Thrombozytenfunktionshemmern. Anaesthesist 2003; 52: 549-566.
- 18 Kozek-Langenecker S, Fries D, Gütl M. et al. Lokoregionalanästhesien unter gerinnungshemmender Medikation. Anaesthesist 2005; 54: 476-484.
- 19 Kubisz P, Stasko J. Recombinant activated factor VII in patients at risk of bleeding. Hematology 2004; 9: 317-332.
- 20 Levi M, Peters M, Buller H. Efficacy and safety of recombinant factor VIIa for treatment of severe bleeding: a systematic review. Crit Care Med 2005; 33: 883-890.
- 21 Mallett S, Cox J. Thrombelastography. Br J Anaesth 1992; 69: 307-313.
- 22 Mayumi T, Dohi S. Spinal subarachnoid hematoma after lumbar puncture in a patient receiving antiplatelet therapy. Anesth Analg 1983; 62: 777-779.
- 23 Miyazaki M, Takasita M, Matsumoto H. et al. Spinal epidural hematoma after removal of an epidu- ral catheter: Case report and review of the literature. J Spinal Disord Tech 2006; 18: 547-51.
- 24 Oden A, Fahlen M. Oral anticoagulation and risk of death: a medical record linkage study. Br Med J 2002; 325: 1073-1075.
- 25 Rigg J, Jamrozik K, Myles P. et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 2002; 359: 1276-1282.
- 26 Rodgers A, Walker N, Schug S. et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Br Med J 2000; 321: 1-12.
- 27 Samama C, Albaladejo P, Benhamou D. et al. Venous thromboembolism prevention in surgery and obstetrics: clinical practice guidelines. Eur J Anaesthesiol 2006; 23: 95-116.
- 28 Samama C, Bastien O, Forestier F. et al. Antiplatelet agents in the periopertive period: expert recommendations of the French Society of Anesthesiology and Intensive Care (SFAR) 2001 – summary statement. Can J Anaesth 2002; 49: S26-S35.
- 29 Schick B, Maslow D, Moshinski A. et al. Novel concatameric heparin-binding peptides reverse heparin and low-molecular-weight heparin anticoagulant activities in patient plasma in vitro and in rats in vivo. Blood 2004; 103: 1356-1363.
- 30 Schröder D. Statistics: detecting a rare adverse drug reaction using spontaneous reports. Reg Anesth Pain Med 1998; 23: 183-189.
- 31 Serebruany V, Malinin A, Eisert R. et al. Risk of bleeding complications with antiplatelet agents: Meta-analysis of 338,191 patients enrolled in 50 randomized controlled trials. Am J Hematol 2004; 75: 40-47.
- 32 Shore-Lesserson L. Point-of-care coagulation monitoring for cardiovascular patients: past and present. J Cardiothorac Vasc Anesth 2002; 16: 99-106.
- 33 Stafford-Smith M. Impaired haemostasis and regional anaesthesia. Can JAnaesth 1996; 43: R129.
- 34 Tryba M. Pro: Rückenmarksnahe Regionalanästhesie und niedermolekulare Heparine. Anästhesiol Intensivmed Notfallmed Schmerzther 1993; 28: 179-181.
- 35 Vandermeulen E, Gogarten W, van Aken H. Risiken und Komplikationsmöglichkeiten der Periduralanästhesie. Anästhesist 1997; 46: 179-186.
- 36 Vandermeulen E, van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg 1994; 79: 1165-1177.
- 37 Warketin T, Crowther M. Reversing anticoagulants both old and new. Can J Anesth 2002; 49: S11-S25.