[Perioperative management of antithrombotic medications in preparation for a locoregional anesthesia technique in patients coming from home to the hospital: the state of play].

Locoregional anesthesia (LRA) techniques play an important role in the perioperative management of patients, providing benefits in terms of analgesia and postoperative recovery. Their main risk is hematoma, which is rare but potentially devastating, particularly during neuraxial techniques and deep peripheral nerve blocks. In patients receiving antithrombotic medications, this risk is higher. Recent recommendations on the management of these antithrombotic agents in the context of LRA distinguish between superficial blocks, which are at low risk, and deep or neuraxial blocks, for which drug-induced coagulopathies require appropriate interruption of treatment. This narrative review describes the preoperative discontinuation times of antithrombotic medications in patients coming from home, before neuraxial or deep peripheral LRA. These delays vary depending on the molecules, their dose, as well as the age, weight and renal function of patients. The different classes of antithrombotic medications and medicinal plants are considered. Possible antidotes will be discussed but have no indication to authorize an elective LRA. In the absence of absolute consensus, the discontinuation of antithrombotic medications before an LRA must be individualized, according to the type of surgery, block, treatment, age and comorbidities. The risk/benefit ratio guides the decision.