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Neuraxial anaesthesia with apixaban — FRCA Final MCQ

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HardRegional AnaesthesiaNeuraxial anaesthesia with apixabanFRCA Final

A 46-year-old man taking apixaban for atrial fibrillation is listed for elective inguinal hernia repair under spinal anaesthesia. Renal function is normal and his last dose was taken the previous evening, 14 hours before the proposed block. What is the most appropriate anaesthetic technique?

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Correct answer: D — Postpone neuraxial block until an appropriate apixaban interval has elapsed

Recent apixaban exposure makes neuraxial puncture unsafe because of the risk of vertebral canal haematoma. A fine needle does not remove the anticoagulant risk, and protamine does not reverse apixaban. Epidural catheterisation increases rather than reduces bleeding consequences. The decision should be based on drug, dose, renal function and current regional anaesthesia anticoagulation guidance.

Reference: Association of Anaesthetists regional anaesthesia and coagulation guideline 2021