Puncture site bleeding complications of peripheral nerve block in patients taking antithrombotic and anticoagulant drugs: An umbrella review

Puncture Site Bleeding in Anticoagulaned Patients

Authors

  • Ahmad Rastgarian Critical Care and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
  • Khatereh Dehghani Department of Cardiology, Jahrom University of Medical Sciences, Jahrom, Iran
  • Shahram Shafa Department of Orthopedics, Jahrom University of Medical Sciences, Jahrom, Iran
  • Mohammad Sadegh Sanie Jahromi Critical Care and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
  • Mansour Deylami Department of Anesthesiology and Critical Care, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
  • Soha Azizi Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
  • Mohammad Zarenezhad Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
  • Kaveh Hedayati Emami Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  • Vahid Rahmanian Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran
  • Tayyebeh Zarei Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
  • Navid Kalani Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran

DOI:

https://doi.org/10.31661/gmj.v12i.2958

Keywords:

Peripheral Nerve Block; Puncture Site Bleeding; Complications; Antithrombotic Agents

Abstract

Background: While there are multiple guidelines for the management of bleeding complications and hematoma if being treated with antithrombotic and anticoagulant drugs, these risks are not yet stratified for procedures with regional anesthesia. Materials and Methods: This study was an umbrella review of systematic studies and meta-analysis based on PRISMA guidelines in databases of Scopus, PubMed, Medline, Cochrane Library, and Web of Science databases. Due to heterogeneity in evaluated outcomes and methods of studies, only the qualitative evidence synthesis was performed. AMSTAR checklist was used to assess the risk of bias in included systematic reviews. Results: After an extensive search of relevant studies, 971 primary cases were identified. Following a thorough screening process, 5 systematic reviews were selected. The evidence suggests that head and neck punctures generally do not result in bleeding complications, except for rare cases of hematoma associated with Infraclavicular brachial plexus block. A deep cervical plexus block is not recommended. Interscalene blocks have varying findings, with some studies reporting hematoma incidence and spinal injury, while others consider them low risk. Supraclavicular brachial plexus block might be associated with hemothorax and infraclavicular blocks are not favored by reviews. Axillary brachial plexus blocks have a minor incidence of hematoma. Abdomen blocks, TAP blocks, ilioinguinal blocks, and rectus sheath blocks carry a higher risk of hematoma. Pectoral nerve (PECS) blocks have a relatively high risk, while paravertebral and intercostal blocks are considered high risk, but further research is needed regarding paravertebral blocks. Conclusion: The available evidence from systematic reviews and studies suggests varying levels of risk for different blocks and procedures that should be considered before decision-making.

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Published

2023-10-30

Issue

Vol. 12 (2023): 2023

Section

Review Article

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