Safety issues : Anticoagulation and neuraxial blockade

Neuraxial blockade includes techniques of spinal or epidural anesthesia and continuous epidural analgesia. A rare but potentially catastrophic complication of neuraxial blockade is spinal hematoma and subsequent paraplegia. The risk of this complication is increased with patient specific risk factors, and with the concomitant use of antithrombotic drugs. 1 The American Society of Regional Anesthesia and Pain Medicine have provided guidelines on the management of patients receiving neuraxial anesthesia and anticoagulation. While the anesthesia staff may be familiar with these guidelines, other practitioners may not be aware of them. In a retrospective review, we found that only eight of 69 (12%) patients with an indwelling epidural catheter over a 12-month period received no concomitant medications that may affect the coagulation system. Two patients received medications, which the guidelines recommend against. Patients receiving neuraxial anesthesia are at high risk to be prescribed medications that may affect coagulation. The pharmacy needs to assume vigilance and responsibility to notify anesthesiology or develop some fail-safe method for these orders to be screened and evaluated. Pharmacy software vendors could assist in this challenge by developing the software to effectively contend with this therapeutic issue.