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Anticoagulation

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Abstract

The American Society of Regional Anesthesiologists and Pain Medicine (ASRA) recently published specific recommendations to reduce the risk of bleeding and neurological injury in patients on anticoagulant and antiplatelet medications. These guidelines stratify interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. Recommendations were evidence-based when available and pharmacology-driven otherwise. Although ASRA guidelines provide sound recommendations, a case-by-case approach must be taken to balance between bleeding and thromboembolism risk to safely manage pain interventions in patients on antiplatelet/anticoagulant therapy.

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References

  1. Tryba M. Epidural regional anesthesia and low molecular heparin: pro (German). Anasth Intesivmed Notfallmed Schmerzther. 1993;28(3):179–81.

    Article  CAS  Google Scholar 

  2. Deer T, Narouze S, Provenzano D, Pope J, Falowski S, Russo M, et al. The Neurostimulation Appropriateness Consensus Committee (NACC): recommendations on bleeding and coagulation management in neurostimulation devices. Neuromodulation. 2017;20:51–62.

    Article  Google Scholar 

  3. Patrono C, Ciabattoni G, Patrignani P, Pugliese F, Filabozzi P, Catella F, et al. Clinical pharmacology of platelet cyclooxygenase inhibition. Vasc Endovasc Surg. 1985;72(6):1177–84.

    CAS  Google Scholar 

  4. Gresele P, Momi S, Falcinelli E. Anti-platelet therapy: phosphodiesterase inhibitors. Br J Clin Pharmacol. 2011;72(4):634–46.

    Article  CAS  Google Scholar 

  5. Wallentin L. P2Y(12) inhibitors: differences in properties and mechanisms of action and potential consequences for clinical use. Eur Heart J. 2009;30(16):1964–77.

    Article  CAS  Google Scholar 

  6. Verhoef T, Redekop W, Daly A, van Schie R, de Boer A, Maitland-van der Zee A. Pharmacogenetic-guided dosing of coumarin anticoagulants: algorithms for warfarin, acenocoumarol and phenprocoumon. Br J Pharmacol. 2014;77(4):626–41.

    Article  CAS  Google Scholar 

  7. King C, Holley A, Jackson J, Shorr A, Moores L. Twice versus three times daily heparin dosing for thromboembolism prophylaxis in the general population: a metaanalysis. Chest. 2007;131(2):507–16.

    Article  CAS  Google Scholar 

  8. Hirsch J, Warkentin T, Shaughnessy S, Anand S, Halperin J, Raschke R, et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001;119(1 Suppl):64S–94S.

    Article  Google Scholar 

  9. Tripodi A. The laboratory and the direct oral anticoagulants. Blood. 2013;121(20):4032–5.

    Article  CAS  Google Scholar 

  10. EINSTEIN Investigators, Bauersachs R, Berkowitz S, Brenner B, Buller H, Decousus H, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26):2499–510.

    Article  Google Scholar 

  11. Frost C, Nepal S, Wang J, Schuster A, Byon W, Boyd R, et al. Safety, pharmacokinetics and pharmacodynamics of multiple oral doses of apixaban, a factor Xa inhibitor, in healthy subjects. Br J Clin Pharmacol. 2013;76(5):776–86.

    Article  CAS  Google Scholar 

  12. Dasgupta H, Blankenship J, Wood G, Frey C, Demko S, Menapace F. Thrombocytopenia complicating treatment with intravenous glycoprotein IIb/IIIa receptor inhibitors. A pooled analysis. Am Heart J. 2000;140(21):206–11.

    Article  CAS  Google Scholar 

  13. Jeong B, Kim S, Kim S, Kim J, Shin I, Yoon J. Use of serotonergic antidepressants and bleeding risk in patients undergoing surgery. Psychosomatics. 2014;55(3):213–20.

    Article  Google Scholar 

  14. Chan K, Lo A, Yeung J, Woo K. The effects of Danshen (Salvia miltiorrhiza) on warfarin pharmacodynamics and pharmacokinetics of warfarin enantiomers in rats. J Pharm Pharmacol. 1995;47(5):402–6.

    Article  CAS  Google Scholar 

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Correspondence to Selaiman A. Noori .

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Noori, S.A., Mehta, N. (2019). Anticoagulation. In: Abd-Elsayed, A. (eds) Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-99124-5_97

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  • DOI: https://doi.org/10.1007/978-3-319-99124-5_97

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-99123-8

  • Online ISBN: 978-3-319-99124-5

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