AANA journal
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An increasing number of surgical patients preoperatively are taking anticoagulant medications. These patients are at an increased risk for development of epidural hematoma with spinal or epidural anesthesia. It is the responsibility of the anesthesia provider to understand and anticipate this risk and to alter the anesthetic plan accordingly. ⋯ Antiplatelet drugs, oral anticoagulants, heparin, low-molecular-weight heparin, other new anticoagulants, and herbal medications are reviewed. When spinal or epidural anesthesia is considered for a patient who has been taking anticoagulant medications, the risk of epidural hematoma vs the benefits of regional anesthesia must be weighed carefully. Appropriate management of the patient extends well into the postoperative period and should include anesthesia providers, attending physicians, and nurses.