Background and Aims The aim of the study was to assess the degree of compliance to current guidelines of perioperative antithrombotic therapy management for patients undergoing surgery under regional anesthesia.

Methods During the year 2019 any patient receiving antithrombotic therapy that underwent surgery in “G. Papanicolaou” under regional anesthesia were enrolled in this retrospective study. Ethics committee approval was acquired. Follow-up was performed 1 month postoperatively in order to identify possible thrombotic or hemorrhagic complications.

Results A total of 274 patients were enrolled. 24.1% (n=66) were receiving DOACs, 7.3% (n=20) received VKAs and 71.5% (n=196) were treated with antiplatelet agent(s). These drugs were managed perioperatively by the respective surgeons or cardiologists and in a lesser degree by anesthesiologists. Compliance was judged taking into account the most up to date guidelines regarding each specific antithrombotic agent. Recent guidelines regarding the perioperative management of antithrombotic therapy for patients about to receive regional anesthesia applied only for the few patients that anesthesiologists were consulted.

Conclusions The main conclusion of this study is that a lesser degree of compliance is evident between patients under DOACs. Management of these agents proves more challenging than antiplatelets or VKAs. The errors in the perioperative management lie both in the longer than suggested period of withdrawal before surgery and bridging with LMWH that is prevalent when it should not be. Finally, a correlation between the appropriate perioperative management of antithrombotic agents and postoperative thrombotic complications was not observed in our sample. There proves to be ample space for improvement and future audits.