An Overview of ASRA Guidelines for Patients on Anticoagulants Undergoing Pain Procedures

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Regional Anesthesia and Pain Medicine appointed a committee to develop separate guidelines for pain interventions in this specific group of patients on antiplatelet and anticoagulant medications.
Regional Anesthesia and Pain Medicine appointed a committee to develop separate guidelines for pain interventions in this specific group of patients on antiplatelet and anticoagulant medications.

After the American Society of Regional Anesthesia and Pain Medicine (ASRA) hosted its 11th Annual Pain Medicine Meeting, which occurred back in 2012, the group learned that existing guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications did not meet the needs of physicians. In response, the society's journal, Regional Anesthesia and Pain Medicine, appointed a committee to develop separate guidelines for pain interventions in this specific group of patients. In his weekly podcast, Dr. Rosenblum, MD, reviewed some of the updated guidelines published by the committee in the spring of 2015

Stopping Anticoagulant or Antiplatelet Medications

The key point in the ASRA guidelines is that before stopping anticoagulant or antiplatelet medications, it is important to collaborate with the patient's primary care physician, cardiologist, or neurologist to determine whether the patient can stop the medications and for how long. It varies from patient to patient and depends on their individual physiology.

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Procedure Classifications According to Risk

The 2015 ASRA guidelines categorize procedures depending on their risk: high risk, intermediate risk, and low risk. The categories are outlined below:

High Risk Procedures

  • SCS trial and implant
  • Intrathecal catheter and pump implant
  • Vertebral augmentation (vertebroplasty and kyphoplasty)
  • Epiduroscopy and epidural decompression

Intermediate Risk Procedures

  • Interlaminar ESIs (CTLS)
  • Transforaminal ESIs (CTLS)
  • Facet MBNB and RFA (CTL)
  • Paravertebral block (CTL)
  • Intradiscal procedures (CTL)
  • Sympathetic blocks (stellate, thoracic, splanchnic, celiac, lumbar, hypogastric)
  • Peripheral nerve stimulation trial and implant
  • Pocket revision and IPG/ITP replacement
  • C = cervical, L = lumbar, MBNB = medical branch nerve block, RFA = radiofrequency ablation, S = sacral, T = thoracic

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