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Central neural blockade in patients with a drug-induced alteration of coagulation. Third edition of the belgian Association for Regional Anaesthesia (BARA) Guidelines.

The first edition of the Belgian guidelines on antithrombotics and central neuraxial anesthesia was published in the year 2000, followed by the second edition in 2005 (1, 2). These guidelines provided Belgian anesthetists with a framework to hold on to when managing patients treated with antithrombotic therapy. Since 2005, however, new information on the risk of central neural blocks in patients treated with antithrombotics has emerged and new antithrombotic agents have become available. In our modern Western civilization, cardiovascular disease remains the number one cause of morbidity and mortality and – as our population ages progressively – there is an increased need for drugs that prevent or treat arterial and/or venous thromboembolism. In addition, case reports suggesting that the risk of a spinal hematoma may be higher than previously thought (3-7) continue to appear in the anesthetic literature. Taken together, these facts all substantiate the necessity of an update of these guidelines.