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MANAGEMENT OF ANTICOAGULANTS BEFORE PERIPHERAL NERVE BLOCKS: EVALUATION OF FRENCH PRACTICES
ESRA Academy. Ortais G. Sep 8, 2016; 138384
Topic: Anticoagulation- Haemorrhagic Complications
Ms. Grégoire Ortais
Ms. Grégoire Ortais

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Abstract
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Background and Aims:

Ultrasound guidance has improved efficiency and safety in Peripheral Nerves Blocks (PNBs). Nevertheless, management of Vitamin K Antagonists (VKAs) and Direct Oral AntiCoagulants (DOACs) before PNB remains debated. ASRA guidelines propose to discontinue VKAs 5 days before PNB. ESA guidelines suggest the possibility of superficial block performance with the use of anticoagulation. In order to assess the French professional practices, we proposed a survey on anticoagulant’s management before PNB.

Methods:

The survey was disseminated among French anaesthetists, via  ESRA mailing list. Questions explored their anticoagulant's management practice when performing PNB (divided in 3 classes depending of the potential risk of complications: superficial block, uncompressible deep block  and interscalene block). A distinction was made according to the guidance technique: ultrasound or nerve stimulator.

Results:

222 anaesthesiologists answered the survey. In patients treated with VKAs, 90% of the anaesthesiologists agreed  to perform a superficial PNB with INR> 1.5. Regarding the DOACs, practices were very heterogeneous (Figure 1). Factors that influenced the discontinuation of the treatment before PNB  were: guidance technique, curative dose of DOACs, deep blocks placement. Anticoagulant’s management was the same for deep PNB and interscalene block. The use of ultrasound guidance seemed necessary for 96% of the practitioners.

Conclusions:

Our results are in accordance with recent literature (1). In superficial PNB,  indications seem to be extended to INR< 2.5. For DOACs, our survey highlights the variations in practice. It suggests the need of guidelines for anti-haemostatic’s management before PNB with a classification of blocks according to their bleeding risk.

(1) BJA 2013 ; 110(3),486-7

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