Locoregional anesthesia and blood coagulation: impact of new antiplatelet drugs

New antiplatelet drugs such as glycoprotein IIb/IIIa receptor antagonists, thienopyridines (adenosine diphosphate receptor antagonists), inhibitors of cyclooxygenase and phosphodiesterase, and antiaggregatory prostaglandins have been introduced in vascular medicine. This paper reviews the pharmacokinetics, mechanisms of action, indications, and side effects of platelet-inhibiting agents as well as methods for coagulation monitoring. Updated guidelines for the management of locoregional anesthesia in patients receiving new antiplatelet drugs are discussed. In this clinical situation,the decision for or against locoregional anesthesia must be preceded by a risk-benefit analysis based on history of bleeding, physical examination, and coagulation monitoring. Blockade should be performed as atraumatically as possible and specific time intervals must be maintained between the last administration of antiplatelet agents and the performance of the blockade or withdrawal of a catheter in all elective patients.