Wed10November0747AM 8

In which one of the following situations is considered safe to perform a central neuraxial block without an increased risk of developing a vertebral canal haematoma?

(Please select 1 option)

A patient on rivaroxaban with a creatinine clearance of 40mL/min 10 hours after the last dose

A patient on streptokinase 5 days following last dose

A patient on subcutaneous low molecular weight heparin (LMWH) prophylaxis 6 hours after last dose

A patient on clopidogrel 7 days after last dose Correct

A patient on subcutaneous unfractionated heparin (UFH) prophylaxis 2 hours after last dose

Explanation

Following the third National Audit Project (NAP3) conducted on behalf of the Royal College of Anaesthetists, the incidence of vertebral canal haematoma after neuraxial blockade was 0.85 per 100 000 (95% CI 0-1.8 per 100 000). Whilst unquantifiable, the incidence of vertebral canal haematoma following neuraxial blockade in coagulopathic patients is likely to be higher. For that reason, a coagulopathy remains a relative contraindication for conducting a spinal or epidural and only performed by experienced personnel having weighed up the balance of risk.

An acceptable time after the last dose of rivaroxaban (in a patient with a creatinine clearance of greater than 30mL/minute) to perform a block is 18 hours.

An acceptable time after the last dose of subcutaneous LMWH as prophylaxis to perform a block is 12 hours.

An acceptable time after the last dose of subcutaneous UFH as prophylaxis to perform a block is 4 hours.

An acceptable time after the last dose of thrombolytic therapy (streptokinase or alteplase) to perform a block is 10 days.

It is common practice to stop clopidogrel 7 days prior to surgery, particularly if a central neuraxial procedure is considered.

References:

Regional Anaesthesia and Patients with Abnormalities of Coagulation. The Association of Anaesthetists of Great Britain & Ireland The Obstetric Anaesthetists' Association (November 2013)

Regional Anaesthesia UK

Answer Statistics

1

2%

2

9%

3

8%

4

80%

5

4%

Times answered: 268