Paravertebral block for multiple rib fractures in an anticoagulated trauma patient

 

The use of oral direct Xa inhibitors (xabans) has become more popular due to superior prevention of ischemic stroke in high-risk patients with atrial fibrillation, prothrombotic or hyper-coagulable states as well as for the management of deep venous thrombosis (DVT) and pulmonary embolism (PE) in comparison to warfarin.

However, rapid reversal of this drug class has proven more challenging given the requirement of coagulation factors especially in patients with severe hemorrhage following acute trauma and/or those requiring emergency surgeries or invasive procedures.

Reversing anticoagulated state before performing paravertebral blocks is crucial to minimizing the risk of bleeding complications, particularly hematoma formation, which can lead to serious consequences such as nerve injury, spinal cord compression, or even death. The use of apixaban in this case increases the risk of bleeding during invasive procedures including regional anesthesia