Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic therapy

Literature review shows insufficient research data that need further studies for:

-    The pharmacologic reversal of the Direct oral anticoagulant (DOAC) effect by using their antidotes to facilitate placement of neuraxial block or deep plexus/peripheral block.

-  The safety of indwelling neuraxial catheters in patients receiving postoperative high-dose UFH has not been established. Definition of the safest interval needs to be defined.

-   No well-established reversal strategy in patients receiving parenteral thrombin inhibitors. Research is needed for Antidotes to the antithrombin effect, so it can be reversed pharmacologically.

-  Lack of specific reversal agent in the patient receiving fondaparinux for safe anagement of neuraxial block or deep plexus/peripheral block.

-    Inspite of the widespread use of herbal medications, there are few controlled clinical trials of the efficacy/adverse effects and few outcome studies of the effects of herbal medications on surgical patients. Data on combination of herbal therapy with other forms of anticoagulation are lacking.

-  Lack of investigations examining the frequency and severity of hemorrhagic complications following plexus or peripheral blockade in anticoagulated patients.