SBA 2020: Regional anesthesia guideline for using
SBA 2020: Atualização na diretriz da anestesia regional em uso de anticoagulantes
Neuber Martins Fonseca, João Paulo Jordão Pontes, Marcelo Vaz Perez, Rodrigo Rodrigues Alves, Gabriel Gondim Fonseca
The development of protocols to prevent perioperative Venous Thromboembolism (VTE) and the introduction of increasingly potent antithrombotic drugs have resulted in concerns of increased risk of neuraxial bleeding. Since the Brazilian Society of Anesthesiology 2014 guide line, new oral anticoagulant drugs were approved by international regulating agencies, and by ANVISA. Societies and organizations that try to approach concerns through guidelines have pre sented conflicting perioperative management recommendations. As a response to these issues and to the need for a more rational approach, managements were updated in the present narra tive review, and guideline statements made. They were projected to encourage safe and quality patient care, but cannot assure specific results. Like any clinical guide recommendation, they are subject to review as knowledge grows, on specific complications, for example. The objective was to assess safety aspects of regional analgesia and anesthesia in patients using antithrom botic drugs, such as: possible technique-associated complications; spinal hematoma-associated risk factors, prevention strategies, diagnosis and treatment; safe interval for discontinuing and reinitiating medication after regional blockade.
Os padrões evolutivos para a prevenção do tromboembolismo venoso perioper- atório e a introdução de medicações antitrombóticas cada vez mais potentes resultaram em preocupações com o aumento do risco de sangramento neuroaxial. Após o consenso da Sociedade Brasileira de Anestesiologia em 2014, novos medicamentos anticoagulantes orais foram aprova dos pelas instituições reguladoras internacionais, assim como pela ANVISA. As sociedades que buscam abordar o manejo perioperatório desses fármacos apresentam recomendações confli tantes. Em resposta a essas questões e à necessidade de uma abordagem mais racional, as condutas foram atualizadas nesta revisão narrativa, e foram feitas novas recomendações, pro jetadas para encorajar a assistência ao paciente de forma segura e de qualidade, mas não podem garantir um resultado específico. Tal como acontece com qualquer recomendação de orientação clínica, estas estão sujeitas a revisão com o conhecimento de avanços específicos de complicações. O objetivo foi avaliar aspectos da segurança em anestesia e analgesia regional em pacientes em uso de medicações antitrombóticas, tais como: possíveis complicações decor rentes da técnica; fatores de risco associados ao hematoma espinhal, estratégias de prevenção, diagnóstico e tratamento; intervalo seguro para suspensão e reinício da medicação após o bloqueio regional.
1. Fonseca NM, Alves RR, Pontes JPJ. Sociedade Brasileira de Anestesiologia. SBA recommendations for regional anesthesia safety in patients taking anticoagulants. Rev Bras Anestesiol. 2014;64:1-15.
2. Horlocker Tt, Vandermeuelen E, Kopp Sl, et al. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med. 2018;43:263-309.
3. Vandermeulen E. Regional anaesthesia and anticoagulation. Best Pract Res Clin Anaesthesiol. 2010;24:121-31.
4. Horlocker TT, Wedel DJ, Schroeder DR, et al. Preoperative antiplatelet therapy does not increase the risk of spinal hematoma associated with regional anesthesia. Anesth Analg. 1995;80:303-9.
5. Stafford-Smith M. Impaired haemostasis and regional anaesthesia. Can J Anaesth. 1996;43:R129-41.
6. Horlocker TT, Wedel DJ. Anticoagulation and neuraxial block: historical perspective, anesthetic implications, and risk management. Reg Anesth Pain Med. 1998;23:129-34.
7. Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology. 2004;101:950-9.
8. Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg. 1994;79: 1165-77.
9. Green L, Machin SJ. Managing anticoagulated patients during neuraxial anaesthesia. Br J Haematol. 2010;149:195-208.
10. Tryba M. Epidural regional anesthesia and low molecular heparin: Pro. Anasthesiol Intensivmed Notfallmed Schmerzther. 1993;28:179-81.
11. Cameron CM, Scott DA, McDonald WM, et al. A review of neuraxial epidural morbidity: experience of more than 8,000 cases at a single teaching hospital. Anesthesiology. 2007;106:997-1002.
12. Cook TM, Counsell D, Wildsmith JA, Royal College of Anaesthetists Third National Audit P. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009;102:179-90.
13. Gogarten W, Vandermeulen E, Van Aken H, et al. Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology. Eur J Anaesthesiol. 2010;27:999-1015.
14. Horlocker Tt, Wedel Dj, Rowlingson Jc, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med. 2010;35:64-101.
15. Narouze S, Benzon HT, Provenzano D, et al. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2018;43:225-62.
16. Lawton MT, Porter RW, Heiserman JE, et al. Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg. 1995;83:1-7.
17. Tryba M, Wedel DJ. Central neuraxial block and low molecular weight heparin (enoxaparine): lessons learned from different dosage regimes in two continents. Acta Anaesthesiol Scand Suppl. 1997;111:100-4.
18. Wulf H. Epidural anaesthesia and spinal haematoma. Can J Anaesth. 1996;43:1260-71.
19. Popping DM, Zahn PK, Van Aken HK, et al. Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth. 2008;101:832-40.
20. Meikle J, Bird S, Nightingale JJ, et al. Detection and management of epidural haematomas related to anaesthesia in the UK: a national survey of current practice. Br J Anaesth. 2008;101:400-4.
21. Breivik H, Bang U, Jalonen J, et al. Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand. 2010;54:16-41.
22. D’alton ME, Friedman AM, Smiley RM, et al. National partnership for maternal safety: consensus bundle on venous thromboembolism. Obstet Gynecol. 2016;45:70617.
23. Leffert L, Butwick A, Carvalho B, et al. The society for obstetric anesthesia and perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants. Anesth Analg. 2018;126:928-44.
24. Waurick K, Riess H, Van Aken H, et al. S1-Leitlinie Rückenmarksnahe regionalanästhesien und thrombembolieprophylaxe/antithrombotische medikation. Anästh Intensivmed. 2014;55:464-92.
25. Rosencher N, Bonnet MP, Sessler DI. Selected new antithrombotic agents and neuraxial anaesthesia for major orthopaedic surgery: management strategies. Anaesthesia. 2007;62:1154-60.
26. Singelyn FJ, Verheyen CC, Piovella F, et al. The safety and efficacy of extended thromboprophylaxis with fondaparinux after major orthopedic surgery of the lower limb with or without a neuraxial or deep peripheral nerve catheter: the EXPERT Study. Anesth Analg. 2007;105:1540-7.
27. Carabini LM, Ramsey GE. Hemostasis and transfusion medicine. In: In: Clinical Anesthesia. eighth edition Wolters Kluwer Health; 2017. p. 1088-91.
28. Cronberg S, Wallmark E, Soderberg I. Effect on platelet aggregation of oral administration of 10 non-steroidal analgesics to humans. Scand J Haematol. 1984;33:155-9.
29. Leese PT, Hubbard RC, Karim A, et al. Effects of celecoxib, a novel cyclooxygenase-2 inhibitor, on platelet function in healthy adults: a randomized, controlled trial. J Clin Pharmacol. 2000;40:124-32.
30. Greensite FS, Katz J. Spinal subdural hematoma associated with attempted epidural anesthesia and subsequent continuous spinal anesthesia. Anesth Analg. 1980;59:72-3.
31. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet. 2000;355:1295-302.
32. CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group. Lancet. 1994;343:619-29.
33. Sibai BM, Caritis SN, Thom E, Shaw K, McNellis D. Low-dose aspirin in nulliparous women: safety of continuous epidural block and correlation between bleeding time and maternal-neonatal bleeding complications. National Institute of Child Health and Human Developmental Maternal-Fetal Medicine Network. Am J Obstet Gynecol. 1995;172: 1553-7.
34. Horlocker TT, Bajwa ZH, Ashraf Z, et al. Risk assessment of hemorrhagic complications associated with nonsteroidal antiinflammatory medications in ambulatory pain clinic patients undergoing epidural steroid injection. Anesth Analg. 2002;95:1691-7, table of contents.
35. Benzon HT, Wong HY, Siddiqui T, et al. Caution in performing epidural injections in patients on several antiplatelet drugs. Anesthesiology. 1999;91:1558-9.
36. Horlocker TT, Wedel DJ. Neuraxial block and low-molecularweight heparin: balancing perioperative analgesia and thromboprophylaxis. Reg Anesth Pain Med. 1998;23:164-77.
37. Hegi TR, Bombeli T, Seifert B, et al. Effect of rofecoxib on platelet aggregation and blood loss in gynaecological and breast surgery compared with diclofenac. Br J Anaesth. 2004;92:523-31.
38. Capodanno D, Ferreiro JL, Angiolillo DJ. Antiplatelet therapy: new pharmacological agents and changing paradigms. J Thromb Haemost. 2013;11:316-29.
39. Osta WA, Akbary H, Fuleihan SF. Epidural analgesia in vascular surgery patients actively taking clopidogrel. Br J Anaesth. 2010;104:429-32.
40. Kawaguchi S, Tokutomi S. A case of epidural hematoma associated with epidural catheterization which occurred on 12 th days after the last medication of ticlopidine hydrochloride. Masui. 2002;51:526-8.
41. Mayumi T, Dohi S. Spinal subarachnoid hematoma after lumbar puncture in a patient receiving antiplatelet therapy. Anesth Analg. 1983;62:777-9.
42. Benzon HT, McCarthy RJ, Benzon HTA, et al. Determination of residual antiplatelet activity of clopidogrel before neuraxial injections. Br J Anaesth. 2011;107:966-71.
43. Asai F, Jakubowski JA, Naganuma H, et al. Platelet inhibitory activity and pharmacokinetics of prasugrel (CS-747) a novel thienopyridine P2Y12 inhibitor: a single ascending dose study in healthy humans. Platelets. 2006;17:209-17.
44. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9 th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141, e326S-e50S.
45. Oprea AD, Popescu WM. Perioperative management of antiplatelet therapy. Br J Anaesth. 2013;111:13-7.
46. Gurbel PA, Bliden KP, Butler K, et al. Randomized doubleblind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation. 2009;120:2577-85.
47. Sible AM, Nawarskas JJ. Cangrelor: A New Route for P2Y12 Inhibition. Cardiol Rev. 2017;25:133-9.
48. Akers WS, Oh JJ, Oestreich JH, et al. Pharmacokinetics and pharmacodynamics of a bolus and infusion of cangrelor: a direct, parenteral P2Y12 receptor antagonist. J Clin Pharmacol. 2010;50:27-35.
49. Angiolillo DJ, Firstenberg MS, Price MJ, et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. JAMA. 2012;307:265-74.
50. De Luca G. Glycoprotein IIb-IIIa inhibitors. Cardiovasc Ther. 2012;30:e242-54.
51. Schror K. The pharmacology of cilostazol. Diabetes Obes Metab. 2002;4:S14-9.
52. Kaneda T, Urimoto G, Suzuki T. Spinal epidural hematoma following epidural catheter removal during antiplatelet therapy with cilostazol. J Anesth. 2008;22:290-3.
53. Sacco RL, Diener HC, Yusuf S, et al. Aspirin and extendedrelease dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med. 2008;359:1238-51.
54. Koenig-Oberhuber V, Filipovic M. New antiplatelet drugs and new oral anticoagulants. Br J Anaesth. 2016;117:ii74-84.
55. Rossini R, Musumeci G, Visconti LO, et al. Perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and non-cardiac surgery: a consensus document from Italian cardiological, surgical and anaesthesiological societies. EuroIntervention. 2014;10: 38-46.
56. Feres F, Costa RA, Abizaid A, et al. Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA. 2013;310: 2510-22.
57. Levine MS, Carucci LR, DiSantis DJ, et al. Consensus Statement of Society of Abdominal Radiology Disease-Focused Panel on Barium Esophagography in Gastroesophageal Reflux Disease. AJR Am J Roentgenol. 2016;207:1009-15.
58. Banerjee S, Angiolillo DJ, Boden WE, et al. Use of Antiplatelet Therapy/DAPT for Post-PCI Patients Undergoing Noncardiac Surgery. J Am Coll Cardiol. 2017;69:1861-70.
59. Kaluza GL, Joseph J, Lee JR, et al. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol. 2000;35:1288-94.
60. Devereaux PJ, Mrkobrada M, Sessler DI, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370:1494-503.SBA 2020: Regional anesthesia guideline for using anticoagulants update
61. Hirsh J, Bauer KA, Donati MB, et al. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8 th Edition). Chest. 2008;133, 141S-59S.
62. Hirsh J, Raschke R, Warkentin TE, et al. Heparin: mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest. 1995;108, 258S-75S.
63. Ruff RL, Dougherty JH Jr. Complications of lumbar puncture followed by anticoagulation. Stroke. 1981;12:879-81.
64. Davignon KR, Maslow A, Chaudrey A, et al. CASE 5 - 2008: Epidural Hematoma: when is it safe to heparinize after the removal of an epidural catheter? J Cardiothorac Vasc Anesth. 2008;22:774-8.
65. Rosen Da, Hawkinberry Dw, Rosen Kr, et al. An epidural hematoma in an adolescent patient after cardiac surgery. Anesth Analg. 2004;98:966-9, table of contents.
66. Liu SS, Mulroy MF. Neuraxial anesthesia and analgesia in the presence of standard heparin. Reg Anesth Pain Med. 1998;23:157-63.
67. Roediger L, Larbuisson R, Lamy M. New approaches and old controversies to postoperative pain control following cardiac surgery. Eur J Anaesthesiol. 2006;23:539-50.
68. Ho AM, Chung DC, Joynt GM. Neuraxial blockade and hematoma in cardiac surgery: estimating the risk of a rare adverse event that has not (yet) occurred. Chest. 2000;117:551-5.
69. Chaney MA. Cardiac surgery and intrathecal/epidural techniques: at the crossroads? Can J Anaesth. 2005;52:783-8.
70. Tryba M. European practice guidelines: thromboembolism prophylaxis and regional anesthesia. Reg Anesth Pain Med. 1998;23:178-82.
71. Sandhu H, Morley-Forster P, Spadafora S. Epidural hematoma following epidural analgesia in a patient receiving unfractionated heparin for thromboprophylaxis. Reg Anesth Pain Med. 2000;25:72-5.
72. King CS, Holley AB, Jackson JL, et al. Twice vs three times daily heparin dosing for thromboembolism prophylaxis in the general medical population: A metaanalysis. Chest. 2007;131:507-16.
73. Working P. Association of Anaesthetists of Great B, Ireland, Obstetric Anaesthetists A, Regional Anaesthesia UK. Regional anaesthesia and patients with abnormalities of coagulation: the Association of Anaesthetists of Great Britain & Ireland The Obstetric Anaesthetists’ Association Regional Anaesthesia UK. Anaesthesia. 2013;68:966-72.
74. Sanderink GJ, Guimart CG, Ozoux ML, et al. Pharmacokinetics and pharmacodynamics of the prophylactic dose of enoxaparin once daily over 4 days in patients with renal impairment. Thromb Res. 2002;105:225-31.
75. Weitz JI, Eikelboom JW, Samama MM. New antithrombotic drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9 th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141, e120S-e51S.
76. Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced thrombocytopenia in patients treated with low-molecularweight heparin or unfractionated heparin. N Engl J Med. 1995;332:1330-5.
77. Douketis JD, Kinnon K, Crowther MA. Anticoagulant effect at the time of epidural catheter removal in patients receiving twice-daily or once-daily low-molecular-weight heparin and continuous epidural analgesia after orthopedic surgery. Thromb Haemost. 2002;88:37-40.
78. Bergqvist D, Lindblad B, Matzsch T. Risk of combining low molecular weight heparin for thromboprophylaxis and epidural or spinal anesthesia. Semin Thromb Hemost. 1993;19: 147-51.
79. Wysowski DK, Talarico L, Bacsanyi J, et al. Spinal and epidural hematoma and low-molecular-weight heparin. N Engl J Med. 1998;338:1774-5.
80. Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med. 2003;28:172-97.
81. Xi M, Beguin S, Hemker HC. The relative importance of the factors II, VII, IX and X for the prothrombinase activity in plasma of orally anticoagulated patients. Thromb Haemost. 1989;62:788-91.
82. Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8 th Edition). Chest. 2008;133, 160S-98S.
83. Enneking FK, Benzon H. Oral anticoagulants and regional anesthesia: a perspective. Reg Anesth Pain Med. 1998;23:140-5.
84. Buvanendran A, Lubenow T, Majewski M, et al. The INR values at removal of epidural catheter in 4013 patients receiving warfarin. Anesthesiology. 2008;109:A427.
85. Parvizi J, Viscusi ER, Frank HG, et al. Can epidural anesthesia and warfarin be coadministered? Clin Orthop Relat Res. 2007;456:133-7.
86. Liu SS, Buvanendran A, Viscusi ER, et al. Uncomplicated removal of epidural catheters in 4365 patients with international normalized ratio greater than 1.4 during initiation of warfarin therapy. Reg Anesth Pain Med. 2011;36:231-5.
87. Kwong LM, Muntz JE. Thromboprophylaxis dosing: the relationship between timing of first administration, efficacy, and safety. Am J Orthop (Belle Mead NJ). 2002;31:16-20.
88. Linkins LA, Dans AL, Moores LK, et al. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9 th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e495S-530S.
89. Eriksson BI, Quinlan DJ, Weitz JI. Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor xa inhibitors in development. Clin Pharmacokinet. 2009;48:1-22.
90. Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med. 2008;358:2765-75.
91. Buller HR, Lensing AW, Prins MH, et al. A dose-ranging study evaluating once-daily oral administration of the factor Xa inhibitor rivaroxaban in the treatment of patients with acute symptomatic deep vein thrombosis: the Einstein-DVT DoseRanging Study. Blood. 2008;112:2242-7.
92. Dias C, Moore KT, Murphy J, et al. Pharmacokinetics, Pharmacodynamics, and Safety of Single-Dose Rivaroxaban in Chronic Hemodialysis. Am J Nephrol. 2016;43:229-36.
93. Kubitza D, Becka M, Wensing G, et al. Safety, pharmacodynamics, and pharmacokinetics of BAY 59-7939–an oral, direct Factor Xa inhibitor - after multiple dosing in healthy male subjects. Eur J Clin Pharmacol. 2005;61:873-80.
94. Ozel O, Demircay E, Kircelli A, et al. Atypical Presentation of an Epidural Hematoma in a Patient Receiving Rivaroxaban After Total Hip Arthroplasty. Orthopedics. 2016;39:e558-560.
95. Radcliff KE, Ong A, Parvizi J, et al. Rivaroxaban-induced epidural hematoma and cauda equina syndrome after total knee arthroplasty: a case report. Orthop Surg. 2014;6:69-71.
96. Madhisetti KR, Mathew M, George M, et al. Spinal epidural haematoma following rivaroxaban administration after total knee replacement. Indian J Anaesth. 2015;59:519-21.
97. Eikelboom JW, Weitz JI. New anticoagulants. Circulation. 2010;121(13):1523-32.
98. Garcia D, Libby E, Crowther MA. The new oral anticoagulants. Blood. 2010;115:15-20.
99. Douxfils J, Chatelain C, Chatelain B, et al. Impact of apixaban on routine and specific coagulation assays: a practical laboratory guide. Thromb Haemost. 2013;110:283-94.
100. Lassen MR, Raskob GE, Gallus A, et al. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet. 2010;375:807-15.
101. Lassen MR, Raskob GE, Gallus A, et al. Apixaban or enoxaparin for thromboprophylaxis after knee replacement. N Engl J Med. 2009;361:594-604.
102. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-92.
103. Ruff CT, Giugliano RP, Antman EM, et al. Evaluation of the novel factor Xa inhibitor edoxaban compared with warfarin in patients with atrial fibrillation: design and rationale for the Effective aNticoaGulation with factor Xa next GEneration in Atrial Fibrillation-Thrombolysis In Myocardial Infarction study 48 (ENGAGE AF-TIMI 48). Am Heart J. 2010;160:635-41.
104. Cohen AT, Harrington R, Goldhaber SZ, et al. The design and rationale for the Acute Medically Ill Venous Thromboembolism Prevention with Extended Duration Betrixaban (APEX) study. Am Heart J. 2014;167:335-41.
105. Chan NC, Bhagirath V, Eikelboom JW. Profile of betrixaban and its potential in the prevention and treatment of venous thromboembolism. Vasc Health Risk Manag. 2015;11:343-51.
106. Chan NC, Hirsh J, Ginsberg JS, et al. Betrixaban (PRT054021): pharmacology, dose selection and clinical studies. Future Cardiol. 2014;10:43-52.
107. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-51.
108. Horlocker Tt. Regional anaesthesia in the patient receiving antithrombotic and antiplatelet therapy. Br J Anaesth. 2011;107:i96-106.
109. Stangier J, Clemens A. Pharmacology, pharmacokinetics, and pharmacodynamics of dabigatran etexilate, an oral direct thrombin inhibitor. Clin Appl Thromb Hemost. 2009;15:9S-16S.
110. Eriksson BI, Dahl OE, Rosencher N, et al. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the REMODEL randomized trial. J Thromb Haemost. 2007;5:2178-85.
111. Fuji T, Fuijita S, Ujihira T, et al. Dabigatran etexilate prevents venous thromboembolism after total knee arthroplasty in Japanese patients with a safety profile comparable to placebo. J Arthroplasty. 2010;25:1267-74.
112. Rosencher N, Noack H, Feuring M, et al. Type of anaesthesia and the safety and efficacy of thromboprophylaxis with enoxaparin or dabigatran etexilate in major orthopaedic surgery: pooled analysis of three randomized controlled trials. Thromb J. 2012;10:9.
113. Pollack CV Jr, Reilly PA, Eikelboom J, et al. Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015;373:511-20.
114. Pollack CV Jr, Reilly PA, Weitz JI. Dabigatran Reversal with Idarucizumab. N Engl J Med. 2017;377:1691-2.
115. Kaplan KL. Direct thrombin inhibitors. Expert Opin Pharmacother. 2003;4:653-66.
116. Kathiresan S, Shiomura J, Jang IK. Argatroban. J Thromb Thrombolysis. 2002;13:41-7.
117. Yeh RW, Jang IK. Argatroban: update. Am Heart J. 2006;151:1131-8.
118. Greinacher A. Lepirudin: a bivalent direct thrombin inhibitor for anticoagulation therapy. Expert Rev Cardiovasc Ther. 2004;2:339-57.
119. Abramovitz S, Beilin Y. Thrombocytopenia, low molecular weight heparin, and obstetric anesthesia. Anesthesiol Clin North Am. 2003;21:99-109.
120. Douglas MJ. Coagulation abnormalities and obstetric anaesthesia. Can J Anaesth. 1991;38:R17-25.
121. Schindler M, Gatt S, Isert P, et al. Thrombocytopenia and platelet functional defects in pre-eclampsia: implications for regional anaesthesia. Anaesth Intensive Care. 1990;18:169-74.
122. Lee LO, Bateman BT, Kheterpal S, et al. Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients: A Report from the Multicenter Perioperative Outcomes Group. Anesthesiology. 2017;126:1053-63.
123. Van Veen JJ, Nokes TJ, Makris M. The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. Br J Haematol. 2010;148:15-25.
124. Estcourt LJ, Malouf R, Hopewell S, et al. Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia. Cochrane Database Syst Rev. 2018;4:Cd011980.
125. D’Alton ME, Friedman AM, Smiley RM, et al. National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism. Anesth Analg. 2016;123:942-9.
126. Bates SM, Middeldorp S, Rodger M, et al. Guidance for the treatment and prevention of obstetric-associated venous thromboembolism. J Thromb Thrombolysis. 2016;41:92-128.
127. Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9 th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e691S-736S.
128. Ansari J, Carvalho B, Shafer SL, et al. Pharmacokinetics and Pharmacodynamics of Drugs Commonly Used in Pregnancy and Parturition. Anesth Analg. 2016;122:786-804.
129. Bateman BT, Mhyre JM, Ehrenfeld J, et al. The risk and outcomes of epidural hematomas after perioperative and obstetric epidural catheterization: a report from the Multicenter Perioperative Outcomes Group Research Consortium. Anesth Analg. 2013;116:1380-5.
130. Algert CS, Bowen JR, Giles WB, et al. Regional block versus general anaesthesia for caesarean section and neonatal outcomes: a population-based study. BMC Med. 2009;7:20.
131. Beckmann M, Calderbank S. Mode of anaesthetic for category 1 caesarean sections and neonatal outcomes. Aust N Z J Obstet Gynaecol. 2012;52:316-20.
132. Moore ER, Bergman N, Anderson GC, et al. Early skin-toskin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016;11:Cd003519.
133. Brancazio LR, Roperti KA, Stierer R, et al. Pharmacokinetics and pharmacodynamics of subcutaneous heparin during the early third trimester of pregnancy. Am J Obstet Gynecol. 1995;173:1240-5.
134. Lebaudy C, Hulot JS, Amoura Z, et al. Changes in enoxaparin pharmacokinetics during pregnancy and implications for antithrombotic therapeutic strategy. Clin Pharmacol Ther. 2008;84:370-7.
135. Friedman AM, D’Alton ME. Venous thromboembolism bundle: Risk assessment and prophylaxis for obstetric patients. Semin Perinatol. 2016;40:87-92.
136. Kurzel RB, Au AH, Rooholamini SA. Retroperitoneal hematoma as a complication of pudendal block. Diagnosis made by computed tomography. West J Med. 1996;164:523-5.
137. Mishio M, Matsumoto T, Okuda Y, et al. Delayed severe airway obstruction due to hematoma following stellate ganglion block. Reg Anesth Pain Med. 1998;23:516-9.
138. Singh SK, Katyal S, Kumar A, et al. Massive hemothorax: A rare complication after supraclavicular brachial plexus block. Anesthesia, essays and researches. 2014;8:410-2.
139. Clendenen SR, Robards CB, Wang RD, et al. Case report: continuous interscalene block associated with neck hematoma and postoperative sepsis. Anesth Analg. 2010;110:1236-8.SBA 2020: Regional anesthesia guideline for using anticoagulants update
140. Parvaiz MA, Korwar V, McArthur D, et al. Large retroperitoneal haematoma: an unexpected complication of ilioinguinal nerve block for inguinal hernia repair. Anaesthesia. 2012;67:80-1.
141. Rodriguez J, Taboada M, Garcia F, et al. Intraneural hematoma after nerve stimulation-guided femoral block in a patient with factor XI deficiency: case report. J Clin Anesth. 2011;23: 234-7.
142. Warner Ns, Duncan Cm, Kopp Sl. Acute Retroperitoneal Hematoma After Psoas Catheter Placement in a Patient with Myeloproliferative Thrombocytosis and Aspirin Therapy. A A Case Rep. 2016;6:28-30.
143. Maier C, Gleim M, Weiss T, et al. Severe bleeding following lumbar sympathetic blockade in two patients under medication with irreversible platelet aggregation inhibitors. Anesthesiology. 2002;97:740-3.
144. Marhofer P, Willschke H, Kettner S. Current concepts and future trends in ultrasound-guided regional anesthesia. Curr Opin Anaesthesiol. 2010;23:632-6.
145. Abrahams MS, Aziz MF, Fu RF, et al. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102:408-17.
146. Martins LE, Ferraro LH, Takeda A, et al. Ultrasound-guided peripheral nerve blocks in anticoagulated patients - case series. Rev Bras Anestesiol. 2017;67:100-6.