fondaparinux and Hematoma--Epidural--Spinal

Topics: Anesthesia, Obstetrical; Anesthesia, Spinal; Anticoagulants; Aspirin; Clopidogrel; Female; Fibrinolytic Agents; Fondaparinux; Guidelines as Topic; Hematoma, Epidural, Spinal; Heparin; Hirudins; Humans; Polysaccharides; Pregnancy; Ticlopidine; Warfarin

Topics: Anticoagulants; Arthroplasty, Replacement, Knee; Arthroscopy; Drug Administration Schedule; Fondaparinux; Hematoma, Epidural, Spinal; Hematoma, Subdural, Spinal; Heparin; Heparin, Low-Molecular-Weight; Hip Fractures; Humans; Polysaccharides; Postoperative Complications; Practice Guidelines as Topic; Premedication; Punctures; Soft Tissue Injuries; Thromboembolism; Venous Thrombosis; Wounds and Injuries

Antithrombotic drugs are known to increase the risk of spinal epidural hematoma after neuraxial blockade. During the last few years, several new anticoagulants have been introduced, some of them more potent than the drugs currently available. More potency, however, may also indicate a higher risk of bleeding.. Case series from the last few years indicate that spinal epidural hematoma is more common then previously estimated, with a prevalence from 1: 100,000 in obstetric patients to as high as 1: 3,600 in female orthopedic patients. In order to diminish this risk, most national societies have issued guidelines in which time intervals were established between administration of antithrombotic drugs and performance of neuraxial blockade.. Guidelines are perceived to be capable of reducing the incidence of spinal epidural hematoma with the inherent risk of permanent paraplegia. These guidelines, however, will only be a valuable aid for clinicians if they are constantly updated and newer antithrombotic drugs are included. Although the resurge of peripheral nerve blocks may diminish patient hazards, deep nerve blocks such as lumbar sympathetic blockade are not devoid of serious complications and should probably be handled in the same way as neuraxial blockade.

Topics: Adenosine Diphosphate; Anesthesia, Conduction; Anesthesia, Epidural; Aspirin; Cardiac Surgical Procedures; Clinical Trials as Topic; Drug Administration Schedule; Female; Fibrinolytic Agents; Fondaparinux; Hematoma, Epidural, Spinal; Heparin, Low-Molecular-Weight; Humans; Nerve Block; Pain Measurement; Pain, Postoperative; Plant Preparations; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Polysaccharides; Practice Guidelines as Topic; Prevalence; Risk Assessment; Risk Factors