Regional anaesthesia in patients taking anticoagulant drugs

Managing perioperative anticoagulation and antiplatelet medication is a daily challenge for anaesthetists. Balancing the risks of surgical bleeding and complications of regional anaesthesia must be weighed against time to theatre and the risk of perioperative thrombotic events. The anaesthetist is particularly concerned about compressive vertebral canal haematomas (VCH) which may occur following spinal, epidural or para-vertebral techniques. There is also concern about bleeding complications following peripheral nerve blockade. This article attempts to put the risk of these complications into context and references key international guidelines on peri-procedural management of the broad range of anticoagulant and antiplatelet medication in current use.