Regional anesthesia and anticoagulant drugs: A survey of current Italian practice

Regional analgesia/anesthesia was used in 38.9% of the procedure. We identified a huge variety of responses regarding management of RA and anti-thrombotic drugs. Not all the responders strictly follow guidelines, also because, in many cases, authors from different countries don't agree each other and suggest different behaviors. Most of responders don't follow a common approach and more the agreement between different guidelines, less the differences in anesthetists behavior. In many cases, particularly with ASA and NSAIDs, new drugs (fondaparinux, thienopyridine derivates) and warfarin, the lack of common suggestions in literature leads to a very confused situation, in which everyone has different ways to approach the problem, particularly in time interval they wait between drug administration and block performance/catheter manipulation (also in the same hospital and with the same patient); thus leading, sometimes, to go against main advices coming from different authors (sometimes the only on which they agree), creating dangerous situation for the patient (concomitant use of two anti-thrombotic drugs in people undergoing RA). In conclusion, more studies and guidelines are required to provide a better knowledge on the use of anti-thrombotic drugs, in order to lead to more accurate guidelines and to reduce hemorrhagic risk.