This episode discusses the main findings from a 2025 review by Suleiman et al. published in BJA, examining how we should manage direct oral anticoagulants (DOACs) in patients having neuraxial anesthesia and deep peripheral nerve blocks. Traditionally, the ASRA guidelines have leaned heavily on long DOAC interruption times and selective drug level testing to avoid the rare but devastating complication of spinal epidural hematoma. But new evidence—from the PAUSE strategy and the PAUSE-2 pilot trial—suggests that shorter, pharmacokinetics-based DOAC holds may offer comparable safety without increasing thromboembolic risk.

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Rethinking DOACs for Neuraxial & Deep Blocks

Anesthesia Updates