Anest. intenziv. Med. 2012;23(6):290-294

Acute warfarin reversal and the use of subarachnoid anaesthesiaAnaesthesiology - Original Paper

Jindrová Barbora^1,*, Kříž Petr¹, Kvasnička Jan², Burget Filip³, Kraus Josef³, Stříteský Martin¹, Michálek Pavel¹

¹ Klinika anestezie, resuscitace a intenzivní medicíny 1. LF UK v Praze a VFN v Praze

² Centrální hematologické laboratoře, Trombotické centrum 1. LF UK v Praze a VFN v Praze

³ 1. chirurgická klinika 1. LF UK v Praze a VFN v Praze

Objectives:
The use of neuraxial blocks in patients on warfarin remains controversial. Patients on warfarin may be reversed, according to the Czech Society for Thrombosis and Haemostasis guidelines, using fresh frozen plasma and vitamin K or the concentrate of prothrombin complex factor.

Design:
A cohort of 21 patients, who were a part of a prospective randomized study.


Settings:
Department of Anaesthesia and Intensive Medicine and 1st Department of Surgery, University Hospital.

Materials and methods:
Patients chronically on warfarin (INR > 1.5) indicated for emergency surgical repair of the proximal femur fracture were included in the study. The effect of warfarin was reversed using fresh frozen plasma and vitamin K or prothrombin complex concentrate prior to surgery. Unilateral subarachnoid anaesthesia was chosen as the anaesthetic technique.

Results:
The average INR value was 2.71 (SD 1.31) before reversal and 1.22 (SD 0.14) after reversal. Unilateral subarachnoid anaesthesia with a mixture of 0.5% hyperbaric bupivacaine and morphine was used in all cases. The average number of punctures was 2.23 (SD 1.41). No complications related to the neuraxial block were recorded.

Conclusion:
Given the estimated incidence of spinal haematoma, it would be necessary to include approximately 2.2 million patients for statistically significant confirmation of the safety of subarachnoid anaesthesia in patients following urgent warfarin reversal. However, we consider the use of subarachnoid block as possible if all precautions are fulfilled and the risk/benefit ratio is calculated.

Keywords: warfarin; acute surgery; subarachnoid anaesthesia

Received: June 27, 2012; Accepted: October 1, 2012; Published: December 1, 2012  Show citation