The risk of bleeding complications after pain procedures in anticoagulated patients.

Minimally invasive pain treatment procedures are common and generally low-risk. Complications from bleeding after these procedures are relatively uncommon, but the neurologic sequelae can be severe, particularly in the case of spinal hematomas. Changes in coagulative, fibrinolytic, and thrombolytic mechanisms escalate these risks. Consensus guidelines developed by the American Society of Regional Anesthesia summarize the risks of spinal hematoma associated with the use of different anticoagulant medications. In addition, these guidelines provide recommendations for neuroaxial procedures on patients treated with oral and intravenous anticoagulant medications. Recommendations for the neuroaxial procedures also apply to the peripheral blocks.