Anticoagulation and neuraxial anesthesia

Abstract

Spinal hematoma is a rare and potentially catastrophic complication of spinal or epidural anesthesia. The incidence of neurologic dysfunction resulting from hemorrhagic complications associated with central neural blockade is estimated to be less than 1 in 150,000 epidural! and less than 1 in 220,000 spinal anesthetics. The decision to perform central neural blockade on a patient receiving thrombolytics, anticoagulants, or antiplatelet medications should be made on an individual basis, weighing the small, though definite risk of spinal hematoma with the benefits of regional anesthesia for a specific patient.