Epidural: ASRA guidelines for anticoagulation

Which of the following risk factors during neuraxial blockade for perioperative pain management has NOT been noted to be associated with catastrophic neurologic injury from spinal hematoma in addition to coagulopathy?

A. increasing age
B. spinal cord or vertebral column abnormality
C. nonsteroidal anti-inflammatory agents
D. difficult needle placement

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Correct Answer: C


Underlying coagulopathy or presence of potent anticoagulants in the bloodstream have been recognized as risk factors for neuraxial hematoma. Due to the link between potent anticoagulants and neuraxial hematoma, the American Society of Regional Anesthesia created a consensus statement and guidelines in order to assist the proceduralist in providing a safe framework for the performance of neuraxial procedures in the anticoagulated patient, which was published in 1998 and updated in 2002 and 2010 focusing on periperative pain procedures, such as spinal and epidural anesthesia. In addition, increasing age (likely with associated spinal cord or vertebral column abnormality), as well as difficult and traumatic neuraxial needle placement, have all been implicated in cases where patients suffered significant neurologic injury from spinal hematoma after neuraxial placement.


Horlocker TT, Wedel DJ, Rowlingson JC, Enneking K, Kopp SL, Benzon HT, Brown DL, Heit JA, Mulroy MF, Rosenquist RW, Tryba M, Yuan CS. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010;35:64-101.

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