ESAIC-ESRA guideline

In early 2019 ESAIC approached ESRA to develop a new guideline on anticoagulants and regional anesthesia. The group was headed by Sibylle Kietaibl and on ESRAs side Clara Lobo, Alan MacFarlane, Thomas Volk and Morné Wolmarans volunteered to work on this project. It has been decided to use a modified PICO method mixed with clinical questions to determine pausing times for anticoagulants and platelet inhibitors. The drugs were restricted to vitamin K antagonists, direct oral antagonists, low molecular weight heparins and unfractionated heparin, Aspirin and P2Y12 inhibitors. The group screened 65.577 publications. As the incidence of an epidural hematoma related to neuraxial blocks or severe bleeding complications after a peripheral block is so low, there were no randomized trials to give a definite answer. The group consequently used simplified pharmacokinetic models and a consensus procedure on 40 grouped recommendations. 23 of these were strong (>90% agreement). Compared to existing national European guidelines there still might be differences. However, as this project represents a European compromise it may hopefully be an aide for national decisions. The whole publication will soon be available online in the European Journal of Anesthesiology.