Regional Anesthesia and Anticoagulation


Key Points

  • Bleeding complications following regional anesthesia are an uncommon but real concern, and are dependent on patient- and procedure-specific factors.

  • A thorough patient history is necessary to identify any preexisting coagulopathy, use of anticoagulants or other agents which may exacerbate bleeding concomitant with regional anesthesia procedures.

  • It is expected that regional anesthesiologists will increasingly encounter patients treated with popular anticoagulant drugs, including NSAIDs, warfarin, heparin, and ADP receptor blockers, as well as newer anticoagulants and other agents affecting coagulation (e.g., SSRIs/SNRIs), as more elderly individuals undergo surgery.

  • Not only do we need to be very knowledgeable about newer developments in the ever changing world of anticoagulation, we also need to temper our enthusiasm for performing invasive procedures on patients who are at high risk for bleeding complications.


Anticoagulation NSAIDs Aspirin Warfarin Heparin Clopidogrel Prasugrel Rivaroxaban Dabigatran Herbal anticoagulants 



American Society of Regional Anesthesia and Pain Medicine


International normalized ratio


Prothrombin time


Partial thromboplastin time


Serotonin norepinephrine reuptake inhibitors


Selective serotonin reuptake inhibitors


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Pain ManagementCleveland ClinicClevelandUSA

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