ASRA Pain Medicine Releases Its Latest Guidelines on Anticoagulation and Regional Anesthesia – An Essential Tool for Patient Safety

This week, the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) published the fifth edition of its Evidence-Based Guidelines on Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy. The recommendations – a hallmark of ASRA Pain Medicine – were originally created in 1998 and have been referenced worldwide as a guide to help clinicians follow the safest possible practices, minimizing bleeding risks while preserving the benefits of regional anesthesia.

Patients who receive anticoagulation therapy—used to treat or prevent embolic complications from atrial fibrillation or deep vein thrombosis to name just a few—face an increased risk of bleeding and complications during regional anesthesia procedures, like spinal, epidural, or nerve blocks. These blocks are often used in orthopedic procedures, childbirth, and pain management. Hemorrhagic complications during regional anesthesia are extremely rare but can have devastating consequences. The guidelines are updated regularly to reflect the latest medications and research findings.

New and Updated Features

The fifth edition builds on decades of expert consensus, incorporating evidence from case reports, clinical trials, pharmacology, and hematology. Highlights include:

• Clearer terminology: Replacing “prophylactic” and “therapeutic” anticoagulant doses with “low dose” and “high dose,” making recommendations easier to apply to individual patients.
• Drug-specific guidance: Recommendations for when to perform blood tests that assess anticoagulation levels, helping tailor care to the patient’s unique needs.
• Patient-first focus: Conservative timing for stopping and restarting anticoagulant medications around procedures, prioritizing safety.

What It Means for Patients

These updates empower clinicians to optimize each patient’s care plan. For example, anticoagulation may not need to be paused for some, reducing unnecessary risk of blood clots, while others may require adjustments to ensure safety during nerve block procedures. The guidelines also stress the importance of vigilance—monitoring for early signs of complications and having protocols in place for immediate response if issues arise.

“ASRA Pain Medicine is committed to advancing patient safety, and these updated recommendations are designed to offer practical, evidence-based tools for all clinicians who incorporate regional anesthesia in their care,” lead author Sandra Kopp, MD, said. Dr. Kopp is an anesthesiologist at Mayo Clinic in Rochester, MN, and treasurer of ASRA Pain Medicine. Coauthors are Erik Vandermeulen, Robert D. McBane, II, MD, Anahi Perlas, MD, FRCPC, Lisa Leffert, MD, and Terese Horlocker, MD. Regional Anesthesia & Pain Medicine, the official publication of the ASRA Pain Medicine, is a monthly scientific journal dedicated to mitigating the global burden of pain.

About ASRA Pain Medicine

ASRA Pain Medicine is the largest organization of its kind with approximately 5,000 members committed to supporting research that promotes the treatment of pain. Its mission is to advance the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education, and advocacy. It accomplishes its mission and vision by addressing the clinical and professional educational needs of physicians and scientists, ensuring excellence in patient care utilizing regional anesthesia and pain medicine, and investigating the scientific basis of the specialty.