{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:16:26Z","timestamp":1771258586918,"version":"3.50.1"},"reference-count":31,"publisher":"BMJ","issue":"11","funder":[{"name":"Deutsche Gesellschaft f\u00fcr An\u00e4sthesiologie und Intensivmedizin e.V.","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Berufsverband Deutscher An\u00e4sthesisten e.V.","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2022,7,22]]},"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The risk of bleeding during regional anesthesia implementation in patients on antithrombotic therapy remains poorly characterized. We; therefore, analyzed bloody tap rates and adjusted ORs comparing patients who take antithrombotic medications with those who do not.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>65,814 qualifying regional anesthetics (2007\u20132019) from the Network for Safety in Regional Anesthesia and Acute Pain Therapy registry were included in a retrospective cohort analysis. Procedures in patients who took antithrombotic drugs were compared with procedures in patients who did not. The primary outcome was bloody puncture, defined as any kind of blood aspiration during placement. Secondarily, we considered timely discontinuation of thromboprophylaxis and the impact of various drug classes. As a sensitivity analysis, we used propensity matched groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Patients on antithrombotic therapy were more likely to have a bloody puncture during peripheral nerve block implementation (adjusted OR 1.60; 95%\u2009CI 1.33 to 1.93; p&lt;0.001) irrespective of whether therapy was discontinued. In contrast, bloody neuraxial blocks were no more common in patients who took antithrombotic medications (adjusted OR 0.95; 95%\u2009CI 0.82 to 1.10; p=0.523) so long as they were paused per guideline. Across both peripheral and neuraxial blocks, concurrent use of more than one platelet and\/or coagulation cascade inhibitor nearly doubled the odds (adjusted OR, 1.89; 95%\u2009CI 1.48 to 2.40; p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Patients on antithrombotic therapy receiving peripheral blocks are at increased risk for bloody punctures irrespective of discontinuation practice. Patients having neuraxial blocks are not at increased risk so long as antithrombotics are stopped per guidelines. Patients who take combined medications are at especially high risk. Guidelines for discontinuing antithrombotic treatments for neuraxial anesthesia appear to be effective and should possibly be extended to high-risk peripheral blocks.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2022-103806","type":"journal-article","created":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T11:25:40Z","timestamp":1659525940000},"page":"653-659","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Antithrombotic drugs and the risk of bloody punctures in regional anesthesia - a retrospective registry analysis"],"prefix":"10.1136","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0981-074X","authenticated-orcid":false,"given":"Christine","family":"Kubulus","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine A","family":"G\u00fcrtesch","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gudrun","family":"Wagenpfeil","sequence":"additional","affiliation":[{"name":"Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel I","family":"Sessler","sequence":"additional","affiliation":[{"name":"Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA; Senior Fellow, Population Health Research Institute, McMaster University, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Volk","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,8,3]]},"reference":[{"key":"2025101110271430000_47.11.653.1","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000763"},{"key":"2025101110271430000_47.11.653.2","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0b013e32833f6f6f"},{"key":"2025101110271430000_47.11.653.3","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1097\/EJA.0000000000001600","article-title":"Regional anaesthesia in patients on antithrombotic drugs: joint ESAIC\/ESRA guidelines","volume":"39","author":"Kietaibl","year":"2022","journal-title":"Eur J Anaesthesiol"},{"key":"2025101110271430000_47.11.653.4","first-page":"464","article-title":"Regional anaesthesia and thromboembolism prophylaxis\/anticoagulation. third revised recommendations of the German Society of anaesthesiology and intensive care medicine","volume":"55","author":"Waurick","year":"2014","journal-title":"An\u00e4sthesie und Intensivmedizin"},{"key":"2025101110271430000_47.11.653.5","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200302000-00044"},{"key":"2025101110271430000_47.11.653.6","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeh242"},{"key":"2025101110271430000_47.11.653.7","first-page":"507","article-title":"Bleeding complications following peripheral regional anaesthesia in patients treated with anticoagulants or antiplatelet agents: a systematic review","volume":"38","author":"Joubert","year":"2019","journal-title":"Anaesth Crit Care Pain Med"},{"key":"2025101110271430000_47.11.653.8","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1007\/s12630-019-01466-w","article-title":"Practice Advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus","volume":"66","author":"Tsui","year":"2019","journal-title":"Can J Anaesth"},{"key":"2025101110271430000_47.11.653.9","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.bja.2017.11.105","article-title":"Haematoma and abscess after neuraxial anaesthesia: a review of 647 cases","volume":"120","author":"Bos","year":"2018","journal-title":"Br J Anaesth"},{"key":"2025101110271430000_47.11.653.10","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000643"},{"key":"2025101110271430000_47.11.653.11","doi-asserted-by":"crossref","DOI":"10.5812\/aapm.43873","article-title":"Epidural haematoma causing paraplegia in a patient with ankylosing spondylitis: a case report","volume":"7","author":"Anipindi","year":"2017","journal-title":"Anesth Pain Med"},{"key":"2025101110271430000_47.11.653.12","article-title":"Ultrasound guidance for upper and lower limb blocks","author":"Lewis","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101110271430000_47.11.653.13","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1111\/anae.13098","article-title":"A systematic review and meta-analysis of ultrasound versus electrical stimulation for peripheral nerve location and blockade","volume":"70","author":"Munirama","year":"2015","journal-title":"Anaesthesia"},{"key":"2025101110271430000_47.11.653.14","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aet196"},{"key":"2025101110271430000_47.11.653.15","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1097\/EJA.0000000000000495","article-title":"Awake, sedated or anaesthetised for regional anaesthesia block placements?: a retrospective registry analysis of acute complications and patient satisfaction in adults","volume":"33","author":"Kubulus","year":"2016","journal-title":"Eur J Anaesthesiol"},{"key":"2025101110271430000_47.11.653.16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885"},{"key":"2025101110271430000_47.11.653.17","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1242127"},{"key":"2025101110271430000_47.11.653.18","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1097\/ALN.0000000000002105","article-title":"Prolonged catheter use and infection in regional anesthesia: a retrospective registry analysis","volume":"128","author":"Bomberg","year":"2018","journal-title":"Anesthesiology"},{"key":"2025101110271430000_47.11.653.19","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1097\/ALN.0000000000001218","article-title":"Single-Dose antibiotic prophylaxis in regional anesthesia: a retrospective registry analysis","volume":"125","author":"Bomberg","year":"2016","journal-title":"Anesthesiology"},{"key":"2025101110271430000_47.11.653.20","first-page":"319","article-title":"Thromboembolism prophylaxis and peripheral nerve blocks for regional anaesthesia. guideline of the German Society of anaesthesiology and intensive care medicine","volume":"46","author":"Buettner","year":"2005","journal-title":"Anaesth Intensivmed"},{"key":"2025101110271430000_47.11.653.21","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-199502000-00017"},{"key":"2025101110271430000_47.11.653.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.01.049"},{"key":"2025101110271430000_47.11.653.23","doi-asserted-by":"publisher","DOI":"10.1214\/09-STS313"},{"key":"2025101110271430000_47.11.653.24","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen300"},{"key":"2025101110271430000_47.11.653.25","doi-asserted-by":"publisher","DOI":"10.1053\/rapm.2003.50027"},{"key":"2025101110271430000_47.11.653.26","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1007\/s00101-018-0499-1","article-title":"Epidural needle insertion : A large registry analysis","volume":"67","author":"Bomberg","year":"2018","journal-title":"Anaesthesist"},{"key":"2025101110271430000_47.11.653.27","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e31825cb3d6"},{"key":"2025101110271430000_47.11.653.28","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2021-102997"},{"key":"2025101110271430000_47.11.653.29","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2021-103296"},{"key":"2025101110271430000_47.11.653.30","doi-asserted-by":"publisher","DOI":"10.1177\/0091270006292127"},{"key":"2025101110271430000_47.11.653.31","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1080\/09537104.2018.1506099","article-title":"Pharmacodynamic safety of clopidogrel monotherapy in patients under oral anticoagulation with a vitamin K antagonist undergoing coronary stent implantation","volume":"30","author":"Valina","year":"2019","journal-title":"Platelets"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2022-103806","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T17:27:25Z","timestamp":1760203645000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2022-103806"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,3]]},"references-count":31,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,9,22]]},"published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1136\/rapm-2022-103806"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2022-103806","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,3]]}}}