Anticoagulantes e bloqueios espinhais

Itagyba Martins Miranda Chaves; Leandro Fellet Miranda Chaves

doi:10.1590/S0034-70942001000300006

Miscellaneous

Anticoagulantes e bloqueios espinhais

Anticoagulants and neuro-axis blockades

Itagyba Martins Miranda Chaves; Leandro Fellet Miranda Chaves

http://dx.doi.org/10.1590/S0034-70942001000300006 Braz J Anesthesiol, vol.51, n3, p.225-234, 2001

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Resumo

JUSTIFICATIVA E OBJETIVOS: Com o uso de anticoagulantes para tromboprofilaxia, a incidência de hematomas em anestesias espinhais aumentou. O objetivo desta revisão é verificar a ocorrência de casos de hematomas espinhais e sua correlação com o uso de drogas utilizadas na tromboprofilaxia. CONTEÚDO: São feitas algumas considerações clínicas e farmacológicas sobre as drogas utilizadas em tromboprofilaxia (cumarínicos, aspirina e heparina). São ressaltados os fatores de risco, particularmente aos relatos de casos de pacientes que desenvolveram hematoma peridural decorrente do uso simultâneo de heparina de baixo peso molecular e anestesia peridural. CONCLUSÕES: Existe importante associação entre hematoma peridural e distúrbios hemorrágicos, principalmente em pacientes em tratamento com anticoagulantes. O reconhecimento do aumento do risco da associação da anestesia peridural, da anestesia subaracnóidea, a continuada vigilância e a educação são fundamentais para evitar futuros casos.

Palavras-chave

ANTICOAGULANTES, COMPLICAÇÕES: hematoma peridural, TÉCNICAS ANESTÉSICAS, Regional: peridural, subaracnóidea

Abstract

BACKGROUND AND OBJECTIVES: The use of anticoagulants for thromboprophylaxis has increased the incidence of spinal blockades hematomas. This review aimed at checking the incidence of spinal hematomas and its correlation with anticoagulant drugs. CONTENTS: Some clinical and pharmacological considerations are made about thromboprophylactic drugs (cumarinics, aspirin and heparin). Risk factors are highlighted, especially those related to patients developing epidural hematomas due to the simultaneous use of low molecular weight heparin and epidural anesthesia. CONCLUSIONS: There is an important correlation between epidural hematomas and hemorrhagic disorders, especially in patients under anticoagulant therapy. The awareness of the increased risk associated to epidural and spinal anesthesia, as well as the continuous surveillance and education are fundamental to prevent future cases.

Keywords

ANESTHETIC TECHNIQUES, Regional: epidural, spinal block, ANTICOAGULANTS, COMPLICATIONS: epidural hematoma

Referências

Horlocker TT. Regional anesthesia and coagulation. ASA Refresher Courses in Anesthesiology. 1998;26:81-94.

Gustafsson H, Rutberg H, Bengtsson M. Spinal haematoma following epidural analgesia: Report of a patient with ankylosing spondylitis and bleeding diasthesis. Anaesthesia. 1988;43:220-222.

Bisinotto FMB, Martins Sobrinho J, Augusto MC. Hematoma sub-dural encefálico após anestesia subaracnóidea. Rev Bras Anestesiol. 1993;43:199-200.

Vieira ZEG, Hergan E. Hematoma sub-dural após raquianestesia contínua e heparinização: apresentação de caso clínico, revisão da literatura e implicações anestesiológicas. Rev Bras Anestesiol. 1992;42:319-324.

Spurny OM, Rubin S, Wolf JW. Spinal epidural hematoma during anticoagulant therapy. Arch Inter Med. 1964;114:103-107.

Stow PJ, Burrows FA. Anticoagulants in anaesthesia. Can J Anaesth. 1987;34:632-649.

Vandermeulen EP, Aken HV, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg. 1994;79:1165-1177.

Macdonald R. Aspirin and extradural blocks. Br J Anaesth. 1991;66:1-3.

Hindman BJ, Koka BV. Usefulness of the post-aspirin bleeding time. Anesthesiology. 1986;64:368-370.

Rapaport SI. Preoperative hemostatic evaluation: which tests, if any?. Blood. 1983;61:229-231.

Rodgers RPC, Levin J. A critical reappraisal of the bleeding time. Semin Thromb Hemost. 1990;16:1-20.

Chestnut DH. Anesthesia for high risk obstetric patient. Annual Refresher Course Lectures. 1997;234:1-7.

Cronberg S, Wallmark E, Söderberg I. Effect on platelet aggregation of oral administration of 10 non-steroidal analgesics to humans. Scand J Haematol. 1984;33:155-159.

Horlocker TT, Heit JA. Low molecular weight heparin: biochemistry, pharmacology, perioperative profilaxis regimens,and guidelines for regional anesthetic management. Anesth Analg. 1997;85:874-885.

Wulf H. Epidural anaesthesia and spinal haematoma. Can J Anaesth. 1996;43:1260-1271.

Cheney FW, Domino KB, Kaplan RA. Nerve injury associated with anesthesia: A closed claims analysis. . .

Horlocker TT, Wedel DJ, Schlichting JL. Postoperative epidural analgesia and oral anticoagulant therapy. Anesth Analg. 1994;79:89-93.

Horlocker , Wedel DJ, Schroeder DR. Preoperative antiplelet therapy does not increase the risk of spinal hematoma associated with regional anesthesia. Anesth Analg. 1995;80:303-309.

Rao TLK, El-Etr AA. Anticoagulation following placement of epidural and subarachnoid catheters: An evaluation of neurologic sequelae. Anesthesiology. 1981;55:618-620.

Ruff RL, Dougherty JH. Complications of lumbar puncture followed by anticoagulation. Stroke. 1981;12:879-881.

Bergqvist D, Lindblad B, Mätzsh T. Low molecular weight heparin for thromboprophylaxis and epidural/spinal anaesthesia: is there a risk?. Acta Anaestesiol Scand. 1992;36:605-609.

Modig J. Spinal or epidural anaesthesia with low molecular weight heparin for thromboprophylaxis requires careful postoperative neurological observation. Acta Anaesthesiol Scand. 1992;36:603-604.

Horlocker TT, Wedel DJ. Spinal and epidural blockade and perioperative low molecular weight heparin: smooth sailing on Titanic. Anesth Analg. 1998;86:1153-1156.

Lumpkin MM. FDA public healt advisory. Anesthesiology. 1998;88:27A-28A.

Tryba M, Wedel DJ. Central neuroaxial block and low molecular weight heparin (enoxaparine): lessons learned from different dosages regimens in two continents. Acta Anaesthesiol Scand. 1997;41:100-104.

Paech M. Anticoagulants and regional anesthesia. IARS Review Course Lectures. 2000:47-51.

Rowney DA, Doyle E. Epidural and subarchnoid blockade in children. Anaesthesia. 1998;53:980-1001.

Anticoagulantes e bloqueios espinhais

Anticoagulants and neuro-axis blockades

Itagyba Martins Miranda Chaves; Leandro Fellet Miranda Chaves

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