Regional Anesthesia in Patients on Anticoagulation Therapies—Evidence-Based Recommendations

  • Alan David Kaye
  • Andrew J. Brunk
  • Aaron J. Kaye
  • Jordan S. Renschler
  • Brendon M. Hart
  • Prathima Anandi
  • Shilpa Patil
  • Elyse M. CornettEmail author
  • Charles J. Fox
Other Pain (A Kaye and N Vadivelu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Other Pain


Purpose of Review

Anticoagulant use among patients is prevalent and increasing. It is important for anesthesiologists to be aware of patients on anticoagulants while performing regional anesthesia.

Recent Findings

In recent years, the FDA has approved many new anticoagulants. With new drugs coming to the market, new side effect profiles should be considered when treating patients, especially when using regional anesthesia. Both ASRA and European agencies have laid out recommendations regarding anticoagulant use and neuraxial/regional techniques. Regarding newer anticoagulants, the guidelines for discontinuation prior to neuraxial injection are based on pharmacokinetics, including half-life duration for each drug.


While each clinical scenario requires an individualized approach, general guidelines can serve as a starting point to help with anesthetic planning and potentially improve patient safety in this evolving field.


Regional anesthesia Anticoagulation therapies Neuraxial anesthesia Evidenced-based practice Anticoagulants 


Compliance with Ethical Standards

Conflict of Interest

Andrew J. Brunk, Aaron J. Kaye, Jordan S Renschler, Brendon M. Hart, Prathima Anandi, Shilpa Patil, Elyse M. Cornett, and Charles J. Fox declare no conflict of interest. Alan D. Kaye discloses that he is on the Speakers Bureau for Depomed, Inc. and Merck.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Alan David Kaye
    • 1
  • Andrew J. Brunk
    • 2
  • Aaron J. Kaye
    • 3
    • 4
  • Jordan S. Renschler
    • 5
  • Brendon M. Hart
    • 6
  • Prathima Anandi
    • 7
  • Shilpa Patil
    • 6
  • Elyse M. Cornett
    • 6
    Email author
  • Charles J. Fox
    • 6
  1. 1.Department of AnesthesiologyLSU Health Sciences CenterNew OrleansUSA
  2. 2.Department of AnesthesiologyLSU Health New OrleansNew OrleansUSA
  3. 3.Medical University of South CarolinaCharlestonUSA
  4. 4.Department of AnesthesiologyLSU Health Sciences CenterNew OrleansUSA
  5. 5.Department of AnesthesiologyLSU Health Sciences CenterNew OrleansUSA
  6. 6.Department of AnesthesiologyLSU Health ShreveportShreveportUSA
  7. 7.Department of MedicineVanderbilt University Medical CenterNashvilleUSA

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