Regionalanästhesie und direkte orale Antikoagulanzien

Abstract

New oral anticoagulants (NOAC) are increasingly applied after hip and knee replacement and in patients with non-vavular atrial fibrillation. Patients with cardiac disease benefit from regional anaesthesia, especially catheter-provided postoperative pain relief, but are at higher risk for puncture-related haematoma when NOAC are applied simultaneously. Therefore recommended time intervals between drug application and performance of RA including catheter removal of 22-34 h must be respected. The next dose of NOAC must not be given before 6 h have been elapsed; after bloody tap a delay of 24 h is recommended. The respective time intervals are prolonged in patients with renal insufficiency, especially when Dabigatran is applied, until 36 to 72 h. In general, high risk patients with NOAC undergoing surgery benefit from an interdicsciplinary approach and from less traumatic techniques such as spinal anaesthesia or superficial peripheral nerve blocks.