Regional anaesthesia: Edited by Bernadette VeeringNew anticoagulants and regional anesthesiaLlau, Juan Va,b; Ferrandis, Raquela,cAuthor Information aDepartment of Anesthesia and Critical Care Medicine, Hospital Clínic Universitari bDepartment of Human Physiology, Universidad Católica ‘San Vicente Mártir’, Spain cDepartment of Physiology, Facultad de Medicina, Valencia, Spain Correspondence to Professor Juan V. Llau, Hospital Cinic Universitari, Department of Anesthesia and Critical Care Medicine, Avda. Blasco Ibañez 17, 46010 Valencia, Spain Tel: +34 963 86 26 53; e-mail: [email protected] Current Opinion in Anaesthesiology: October 2009 - Volume 22 - Issue 5 - p 661-666 doi: 10.1097/ACO.0b013e32832eb8ab Buy Metrics Abstract Purpose of review The use of pharmacological thromboprophylaxis in the perioperative period may conflict with regional anesthetic techniques in which maintaining hemostatic integrity is essential. Recently, new anticoagulants have been developed with more efficacy and a better safety profile. This article reviews the basis for the actual recommendations and the current status and management of these new drugs. Recent findings Recent studies have outlined that the risk of epidural hematoma after neuraxial anesthesia may be higher than estimated. Therefore, it is imperative to follow the published recommendations. The use of new anticoagulant drugs may take into account the pharmacological profile of each one to safely perform regional anesthesia, mainly the time to reach peak plasma level and half-life. Summary When new anticoagulant drugs are used for thromboprophylaxis in orthopedic surgery, the performance of neuraxial anesthetic techniques should be based on their pharmacology. If a peripheral blockade is chosen, these recommendations should be followed when a block is performed in a noncompressible area. © 2009 Lippincott Williams & Wilkins, Inc.