Anticoagulation and regional anesthesia in cardiac surgery: safety considerations

This review focuses on the impact of anticoagulation treatment on the use of neuraxial anesthetic techniques in cardiac surgery. After a short risk evaluation, the effects of different agents are discussed: heparin, low molecular weight heparin, antiplatelet and oral anticoagulation agents, thrombolytic drugs, and newer antihemostatic agents all have an impact on the use of neuraxial techniques in cardiac surgery. A detailed understanding of their mode and timing of action is important to safely practice regional techniques in cardiac surgery. Adherence to published guidelines will help to minimize the risk from the procedure and/or any coexisting antihemostatic therapies. The review gives several recommendations on if, how, and when to use neuraxial techniques when anticoagulative agents are involved.