Polypharmacy: Neuraxial anesthesia and anticoagulation

Abstract

Hematoma after epidural anesthesia, while rare, can be a potentially devastating event. This risk is significantly increased in the presence of concomitant antithrombotics. This chapter reviews over FDA approved antithrombotics and discusses a standardized approach to evaluating a patient’s medication regimen prior to placement and removal of an epidural catheter. This chapter also discusses potential systems and process improvements for reinforcing guidelines to the safe use of antiplatelet and anticoagulant medications in patients undergoing interventional spine and pain procedures.