Profilaktyka i leczenie przeciwzakrzepowe a blokady centralne
Stanowisko Zespołu Roboczego Konsultanta Krajowego w dziedzinie anestezjologii i intensywnej terapii

Ryszard Gajdosz¹, Anna Przeklasa-Muszyńska¹, Jan Dobrogowski², Jerzy Wordliczek²

Summary
Thrombosis prophylaxis plays an important role in limiting postoperative complications. The probability of a fatal pulmonary artery embolism after major orthopaedic surgery has been defined as 1:100. In contrast, the probability of an epidural haematoma after single spinal or epidural injections is estimated to be from 1:12 000 to 1:150 000. The use of epidural catheters increases the risk 20-fold, so special attention should be paid to its use in patients with coagulation disturbances, or those receiving thrombosis prophylaxis therapy. The authors present general guidelines for timing, medication and techniques of neuraxial blocks in anticoagulated patients. Special attention is paid to the timing of insertion and removal of indwelling catheters. Long-acting oral anticoagulants should be stopped at least one week before any neuraxial block is performed. Blocks should not be attempted in cases of ongoing fibrinolytic therapy. LMWH should not be given earlier than four hours after a neuraxial block, and an indwelling catheter should not be removed before 12 hours after the last dose of LMWH. Following removal of a catheter, LMWH may be given after two hours. There are no general contraindications for neuraxial blocks in patients being treated with NSDAIDs, with the exception of platelet anti-aggregation drugs (ticlopidine, clopidogrel), which should be stopped two weeks before the attempted block. Vigilance in monitoring is critical to allow early evaluation of neurologic dysfunction and prompt intervention in anticoagulated patients.

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