Skip to main content
SpringerLink
Log in

Lokoregionalanästhesien unter gerinnungshemmender Medikation

Empfehlungen der Arbeitsgruppe Perioperative Gerinnung (AGPG) der Österreichischen Gesellschaft für Anästhesiologie und Intensivmedizin (ÖGARI)

Locoregional anesthesia and coagulation inhibitors

Recommendations of the Task Force on Perioperative Coagulation of the Austrian Society for Anesthesiology and Intensive Care Medicine

  • Regionalanästhesie
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Die Möglichkeiten der medikamentösen Gerinnungshemmung werden zusehens vielfältiger. Leitlinien der Fachgesellschaften sollen die Patientensicherheit erhöhen und zur Vermeidung von blockadeassoziierten Blutungskomplikationen beitragen. Da Leitlinien nicht nur auf pharmakologischen Fakten, sondern auch auf einer sorgfältigen Evaluation vorliegender Fallberichte und der steigenden Erfahrung im Umgang mit neuen Thrombozytenfunktionshemmern und Antithrombotika basieren, müssen sie laufend aktualisiert werden. Die in diesem Artikel beschriebene Empfehlung der Arbeitsgruppe Perioperative Gerinnung der Österreichischen Gesellschaft für Anästhesiologie und Intensivmedizin stellt eine Überarbeitung der Leitlinien der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin zur Vermeidung von Blutungskomplikationen bei rückenmarknaher Regionalanästhesie unter gerinnungshemmender Medikation dar und berücksichtigt darüber hinaus auch periphere Blockaden.

Abstract

More efficacious anticoagulant and antiplatelet agents have been introduced in vascular medicine and in the prevention of perioperative venous thromboembolisms. Patient management should be guided by familiarity with the pharmacology of coagulation-altering drugs and by consensus statements. The present paper reviews recommendations from the Austrian Task Force for Perioperative Coagulation which are based on thorough evaluation of the available pharmacological information and case reports. The consensus statement focuses on neuraxial and peripheral techniques and is designed to encourage safe and quality patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. American Society of Regional Anesthesia and Pain Medicine (2005) http://www.asra.com/. Gesehen 20 Feb 2005

  2. Bauriedel G, Skowasch D, Schneider M et al. (2003) Antiplatelet effects of angiotensin-converting enzyme inhibitors compared with aspirin and clopidogrel: a pilot study with whole-blood aggregometry. Am Heart J 15:343–348

    Google Scholar 

  3. Benzon H, Wong G, Siddiqui T et al. (1999) Caution in performing epidural injections in patients on several antiplatelet drugs. Anesthesiology 91:1558–1559

    Google Scholar 

  4. Chakroun T, Gerotziafas G, Robert F et al. (2004) In vitro aspirin resistance detected by PFA-100TM closure time: pivotal role of plasma von Willebrand factor. Br J Haematol 124:80–85

    Google Scholar 

  5. Chun R, Orser B, Madan M (2002) Platelet glycoprotein IIb/IIIa inhibitors: overview and implications for the anesthesiologist. Anesth Analg 95:879–888

    Google Scholar 

  6. CLASP (Collaborative Low-Dose Aspirin Study in Pregnancy) (1994) CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. Lancet 343:619–629

    Google Scholar 

  7. Dzik W (2004) Predicting hemorrhage using preoperative coagulation screening assays. Curr Hematol Rep 3:324–330

    Google Scholar 

  8. Erikson U, Samuelsson O, Attman P et al. (2004) Melagatran is efficiently eliminated by haemodialysis in ureamic patients (abstract). International Congress on Thrombosis (ICT) Lubljiana, Slovenia

  9. Gerancher J, Waterer R, Middleton J (1997) Transient paraparesis after postdural puncture spinal hematoma in a patient receiving ketorolac. Anesthesiology 86:490–494

    Google Scholar 

  10. Gogarten W, Aken H van, Büttner J et al. (2003) Rückenmarksnahe Regionalanästhesien und Thromboembolieprophylaxe/antithrombotische Medikation. Anasthesiol Intensivmed 44:218–230, http://www.ak-regional.die-narkose.de/framesets/framesetleit.htm. Gesehen 20 Feb 2005

    Google Scholar 

  11. Hezard N, Metz D, Nazeyrollas P et al. (2002) PFA-100 and flow cytometry: can they challenge aggregometry to assess antiplatelet agents, other than GPIIbIIIa blockers, in coronary angioplasty? Thromb Res 108:43–47

    Google Scholar 

  12. Homoncik M, Jilma B, Hergovich N et al. (2000) Monitoring of aspirin (ASS) pharmacodynamics with the platelet function analyzer PFA-100. Thromb Haemost 83:316–321

    Google Scholar 

  13. Horlocker T, Wedel D, Schroeder D et al. (1995) Preoperative antiplatelet therapy does not increase the risk of spinal hematoma associated with regional anesthesia. Anesth Analg 80:303–309

    Google Scholar 

  14. Kam P, Nethery C (2003) The thienopyridine derivates (platelet adenosine diphosphate receptor antagonists), pharmacology and clinical developments. Anaesthesia 58:28–35

    Google Scholar 

  15. Kawaguchi S, Tokumtomi S (2002) A case of epidural hematoma associated with epidural catheterization which occurred on 12th day after the last medication of ticlopidine hydrochloride. Masui 51:526–528

    Google Scholar 

  16. Koscielny J, Ziemer S, Radtke H et al. (2004) A practical concept for preoperative identification of patients with impaired primary hemostasis. Clin Appl Thromb Hemost 10:195–204

    Google Scholar 

  17. Kozek-Langenecker S (2003) Lokoregionalanästhesie und Blutgerinnung: Behandlung mit Thrombozytenfunktionshemmern. Anaesthesist 52:549–566

    Google Scholar 

  18. Langenecker S, Felfernig M, Werba A et al. (1994) Anticoagulation with prostacyclin and heparin during continuous venovenous hemofiltration. Crit Care Med 22:1774–1781

    PubMed  Google Scholar 

  19. Locke G, Giorgio A, Biggers S et al. (1976) Acute spinal epidural hematoma secondary to aspirin-induced prolonged bleeding. Surg Neurol 5:293–296

    Google Scholar 

  20. Madan M, Berkowitz S, Christie D et al. (2001) Rapid assessment of glycoprotein IIb/IIIa blockade with the platelet function analyzer (PFA-100) during percutaneous coronary intervention. Am Heart J 141:226–233

    Google Scholar 

  21. Maier C, Gleim M, Weiss T et al. (2002) Severe bleeding following lumbar sympathetic blockade in two patients under medication with irreversible platelet aggregation inhibitors. Anesthesiology 97:740–743

    Google Scholar 

  22. Mascelli M, Worley S, Verbiabo N et al. (1997) Rapid assessment of platelet function with a modified whole-blood aggregometer in percutaneous transluminal coronary angioplasty in patients receiving anti-GP IIb/IIIa therapy. Circulation 96:3860–3866

    Google Scholar 

  23. Mayumi T, Dohi S (1983) Spinal subarachnoid hematoma after lumbar puncture in a patient receiving antiplatelet therapy. Anesth Analg 62:777–779

    Google Scholar 

  24. McDonald R (1991) Aspirin and extradural blocks. Br J Anaesth 66:1–3

    Google Scholar 

  25. Mishima K, Aritake K, Morita A et al. (1989) A case of acute spinal epidural hematoma in a patient with antiplatelet therapy. No Shinkei Geka 17:849–853

    Google Scholar 

  26. Mukherjee D, Moliterno D (2000) Monitoring antiplatelet therapy. Clin Pharmacokinet 39:445–448

    Google Scholar 

  27. Owens E, Kasten G, Hessel II E (1986) Spinal subarachnoid hematoma after lumbar puncture and heparinization: a case report, review of the literature, and discussion of anesthetic implications. Anesth Analg 65:1201–1207

    Google Scholar 

  28. Pindur G, Ziegeler S, Kleinschmidt S (2004) Melagatran und Ximelagatran. Anaesthesist 52:1171–1175

    Google Scholar 

  29. Pryle B, Carter J, Cadoux-Hudson T (1996) Delayed paraplegia following spinal anesthesia. Spinal subdural haematoma following dural puncture with a 25G pencil point needle at T12-L1 in a patient taking aspirin. Anaesthesia 51:263–265

    Google Scholar 

  30. Reiter R, Mayr F, Blazicek H et al. (2003) Desmopressin antagonizes the in vitro platelet dysfunction induced by GP IIbIIIa inhibitors and aspirin. Blood 102:4594–4599

    Google Scholar 

  31. Rigg J, Jamrozik K, Myles P et al. (2002) Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 359:1276–1282

    Google Scholar 

  32. Rodgers A, Walker N, Schug S et al. (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321:1–12

    Google Scholar 

  33. Rossi F, Rossi E, Pareti F et al. (2001) In vitro measurement of platelet glycoprotein IIb/IIIa receptor blockade by abciximab: interindividual variation and increased platelet secretion. Haematologica 86:192–198

    Google Scholar 

  34. Ruff R, Dougherty J (1981) Complications of lumbar puncture followed by anticoagulation. Stroke 12:879–881

    Google Scholar 

  35. Samama C, Bastien O, Forestier F et al. (2002) Antiplatelet agents in the perioperative period: expert recommendations of the French Society of Anesthesiology and Intensive Care (SFAR) 2001 — Summary statement. Can J Anaesth 49:S26–35

    Google Scholar 

  36. Schramm B, Leslie K, Myles P et al. (2001) Coagulation studies in preoperative neurosurgical patients. Anaesth Intensive Care 29:388–392

    Google Scholar 

  37. Schröder D (1998) Statistics: detecting a rare adverse drug reaction using spontaneous reports. Reg Anesth Pain Med 23:183–189

    Google Scholar 

  38. Serebruany V, Malinin A, Eisert R et al. (2004) Risk of bleeding complications with antiplatelet agents: Meta-analysis of 338,191 patients enrolled in 50 randomized controlled trials. Am J Hematol 75:40–47

    Google Scholar 

  39. Spannagel M, Frey L (2001) Neue Thrombozytenhemmstoffe. Anaesthesist 50:142–149

    Google Scholar 

  40. Stafford-Smith M (1996) Impaired haemostasis and regional anaesthesia. Can J Anaesth 43:R129

    CAS  PubMed  Google Scholar 

  41. Tryba M (1993) Pro: Rückenmarksnahe Regionalanästhesie und niedermolekulare Heparine. Anasthesiol Intensivmed Notfallmed Schmerzther 28:179–181

    Google Scholar 

  42. Tryba M, Wedel D (1997) Central neuraxial block and low molecular weight heparin (enoxaparine): lessons learned from different dosage regimes in two continents. Acta Anaesthesiol Scand 111:100–104

    Google Scholar 

  43. Tyagi A, Bhattacharya A (2002) Central neuraxial blocks and anticoagulation: a review of current trends. Eur J Anaesthesiol 19:317–329

    Google Scholar 

  44. Urmey W, Rowlingson J (1998) Do antiplatelet agents contribute to the development of perioperative spinal hematoma? Reg Anesth Pain Med 23:146–151

    Google Scholar 

  45. Vandermeulen E, Aken H van, Vermylen J (1994) Anticoagulants and spinal-epidural anesthesia. Anesth Analg 79:1165–1177

    Google Scholar 

  46. Vandermeulen E, Gogarten W, Aken H van (1997) Risiken und Komplikationsmöglichkeiten der Periduralanästhesie. Anästhesist 46:179–186

    Google Scholar 

  47. Warketin T, Crowther M (2002) Reversing anticoagulants both old and new. Can J Anesth 49:S11–25

    Google Scholar 

  48. Wheeler G, Baraden GA, Steinhubl S et al. (2002) The Ultegra rapid platelet-funtion assay: comparisons to standard platelet function assays in patients undergoing percutaneous coronary intervention with the abciximab therapy. Am Heart J 143:602–611

    Google Scholar 

  49. Wulf H (1995) Thromboembolieprophylaxe und rückenmarksnahe Regionalanästhesie. Bericht von der Sitzung de wissenschaftlichen Arbeitskreises „Regionalanästhesie“ der DGAI. Anasthesiol Intensivmedizin 36:216–217

    Google Scholar 

  50. Wulf H (1996) Epidural anaesthesia and spinal haematoma. Can J Anaesth 43:1260–1271

    Google Scholar 

  51. Yin B, Barratt S, Power I et al. (1999) Epidural haematoma after removal of an epidural catheter in a patient receiving high-dose enoxaparin. Br J Anaesth 82:288–290

    Google Scholar 

Download references

Interessenkonflikt:

Keine Angaben

Author information

Authors and Affiliations

  1. Universitätsklinik für Allgemeine Anaesthesie und Intensivmedizin B, Wien

    S. A. Kozek-Langenecker

  2. Universitätsklinik für Anaesthesie und Allgemeine Intensivmedizin, Innsbruck

    D. Fries & P. Innerhofer

  3. Universitätsklinik für Anästhesiologie und Intensivmedizin, Graz

    M. Gütl

  4. Abteilung für Anästhesiologie und Intensivmedizin, LKH Salzburg

    N. Hofmann

  5. Abteilung für Anästhesie und Intensivmedizin, KH Lainz, Wien

    W. Kneifl & P. Perger

  6. Abteilung für Anästhesiologie und operative Intensivmedizin, KH Linz

    L. Neuner

  7. 1. Abteilung für Anästhesie, KH Wels

    T. Pernerstorfer

  8. Abteilung für Anästhesiologie und Intensivbehandlung, LKH Feldkirch

    G. Pfanner

  9. Abteilung für Anästhesiologie und Intensivpflege, UKH Salzburg

    H. Schöchl

  10. Universitätsklinik für Anaesthesie und Allgem. Intensivmedizin, Währinger Gürtel 18–20, 1090, Wien, Österrreich

    S. A. Kozek-Langenecker

Authors
  1. S. A. Kozek-Langenecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Fries
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Gütl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Hofmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Innerhofer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W. Kneifl
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. Neuner
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Perger
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. T. Pernerstorfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G. Pfanner
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. H. Schöchl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. A. Kozek-Langenecker.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kozek-Langenecker, S.A., Fries, D., Gütl, M. et al. Lokoregionalanästhesien unter gerinnungshemmender Medikation. Anaesthesist 54, 476–484 (2005). https://doi.org/10.1007/s00101-005-0827-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-005-0827-0

Schlüsselwörter

Keywords

Search

Navigation