Delphi consensus recommendations for neuraxial anaesthesia in adults with platelet disorders and coagulation defects: Communication from the ISTH SSC Subcommittee on von Willebrand factor.

Abstract

Background: Neuraxial anaesthesia is used for pain management in surgical and non-surgical settings. Spinal/epidural haematomas likely occur in between 1:10,000 and 1:200,000 procedures. Risk is thought to be greater in patients with bleeding disorders/thrombocytopenia and there are no existing comprehensive recommendations to guide neuraxial anaesthesia in these patients.

Objectives: The study's objective was to develop recommendations to advise clinicians on treatment thresholds for neuraxial anaesthesia in patients with platelet disorders/coagulation defects.

Methods: A four-round electronic modified Delphi consensus study was conducted. A steering committee generated the original Delphi statements and refined them based on panelist feedback. Consensus was achieved if ≥70% of participants agreed/strongly agreed or disagreed/strongly disagreed with a statement. This project was endorsed by the International Society on Thrombosis and Hemostasis Scientific and Standardization Committee Subcommittee on von Willebrand factor.

Results: Forty-five experts participated (42% response rate) with an essentially equal number of haematologists and anaesthesiologists. Thirty consensus statements were developed for 11 disorders ranging from various causes of thrombocytopenia, inherited platelet function disorders (IPFD), and single or multiple coagulation defects in obstetrical and non-obstetrical patients. Risk of sampling bias is present due to a predominantly North American sample, attrition (common in Delphi studies), and steering committee participation in the Delphi rounds.

Conclusions: This is the first set of consensus recommendations for neuraxial anaesthesia in adult patients with an array of platelet disorders/coagulation defects. These recommendations, based on the best available evidence and expert opinion, provide a decision framework for clinicians when faced with this challenging scenario.