• Gennaro Scibelli, Lucia Maio, and Gennaro Savoia.
• Department of Anaesthesia and Intensive Care, ASL Caserta, Caserta, Italy.
• Minerva Anestesiol. 2017 Mar 1; 83 (3): 321 - 335.

BackgroundThe use of anticoagulant agents represents a serious limitation of regional anesthesia, due to the risk of spinal hematoma. Examining all the principles currently available, it has been possible to notice that published guidelines are very often incomplete or also differ significantly on the rules to be followed relating to a specific drug.MethodsWe have carried out a comparison between the guidelines of major scientific societies in order to take a practical and simple user guide which operators can consult. We took into consideration the more and more frequent occurrence of patients who undergo dual antiplatelet and need to be subjected to surgery, considering the possibility of regional anesthesia as an alternative to general anesthesia in conditions of election and not deferrable urgency.ResultsWe have described the main anticoagulant drugs used in therapy. Regarding the low molecular weight heparins (LMWH), we have reported the most important properties, highlighting the substantial differences of their use detectable by comparison between American and European Guidelines. A similar comparison has been made for the main antiplatelet drugs, including aspirin, and thrombin inhibitors. A particular chapter was dedicated to new oral anticoagulant drugs (NOACs), especially for the low possibility of allowing regional anesthesia.ConclusionsThe comparison between the main guidelines often highlights substantial disparities and weak evidences, so operators must carry out a careful risk / benefit analysis prior to regional anesthesia.

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