Study Questions Anticoagulation Guidelines for Performing Regional Anesthesia Procedures

Newswise — Patients require treatment with blood-thinning medications (anticoagulants) for a variety of medical reasons. One anticoagulant commonly used to prevent and treat blood clots, called enoxaparin, is frequently used around the time of a planned surgery. Two reasons for this are the long-held perceptions that, unlike some other anticoagulants, laboratory monitoring is not usually required and that the blood-thinning effects wane predictably following the last dose. For enoxaparin and many other anticoagulants, published guidelines exist to help clinicians decide when it is likely safe to proceed with invasive procedures, such as spinal injections or epidurals, which carry a low, but serious, risk of bleeding.

Researchers at Wake Forest Baptist Hospital found that despite being 24-hours or more removed from the last treatment dose of enoxaparin, as the American Society of Regional Anesthesia and Pain Medicine guidelines have long suggested, a significant number of patients still had residual anticoagulant activity present, potentially increasing their bleeding risk if a spinal or epidural was performed.

The results suggest that more research is needed to define the value of routine laboratory testing for patients receiving enoxaparin and to determine the optimal period of time to wait following the last treatment dose of enoxaparin before performing a spinal or epidural. Regional Anesthesia and Pain Medicine Fellow James Turner, MD, will present his abstract "Enoxaparin bridging for neuraxial procedures: Is the 24 hour wait really enough?" (abstract #3379) on April 7th at the 42nd Annual Regional Anesthesiology and Acute Pain Medicine Meeting in San Francisco.

ASRA's annual spring meeting will be held April 6-8 at the Marriott Marquis. The meeting attracted a record number of abstract submissions this year and promises to break previous attendance records as well.

ASRA is the largest subspecialty anesthesia association in the United States with more than 4,000 members. The mission of the society is to advance the science and practice of regional anesthesia and pain medicine. The vision of the society is to be the leader in regional anesthesia and chronic pain medicine through innovations in education and research.