Nonsteroidal Antiinflammatory Drugs, Antiplatelet Medications, and Spinal Axis Anesthesia

Medications that affect the platelet function are in common use. Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) are antiplatelet medications that are widely used for different indications. P2Y12 receptor blockers and the platelet glycoprotein (GP) IIb/IIIa antagonists are the more potent platelet aggregation inhibitors indicated specifically in the treatment of arterial thrombosis. They are commonly used in acute coronary syndrome, cerebral stroke, and when angioplasties are performed. They continue to grow in number and tend to increase in potency. Not uncommonly, anesthesiologists find themselves in a position to make a decision of placing a neuraxis anesthesia in a patient who uses antiplatelet medications. Although the American Society of Regional Anesthesia and Pain Medicine (ASRA) has produced robust guidelines on this topic, many of these medications are new with unknown risk or the evidence is still inadequate. Also, areas of uncertainties do exist, such as in placing lumbar puncture urgently with concurrent administration of antiplatelet medications, assay of platelet functions, and reversal of the antiplatelet medications. It is important that anesthesiologists have the pharmacologic knowledge and awareness of the possible risks and options to make the best decisions for these patients.