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BACKGROUND: Bleeding is a potential complication after neuraxial and peripheral nerve blocks. The risk is increased in patients on antiplatelet and anticoagulant drugs. This joint guideline from the European Society of Anaesthesiology and Intensive Care and the European Society of Regional Anaesthesia aims to provide an evidence-based set of recommendations and suggestions on how to reduce the risk of antithrombotic drug-induced haematoma formation related to the practice of regional anaesthesia and analgesia. DESIGN: A systematic literature search was performed, examining seven drug comparators and 10 types of clinical intervention with the outcome being peripheral and neuraxial haematoma. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the methodological quality of the included studies and for formulating recommendations. A Delphi process was used to prepare a clinical practice guideline. RESULTS: Clinical studies were limited in number and quality and the certainty of evidence was assessed to be GRADE C throughout. Forty clinical practice statements were formulated. Using the Delphi-process, strong consensus (>90% agreement) was achieved in 57.5% of recommendations and consensus (75 to 90% agreement) in 42.5%. DISCUSSION: Specific time intervals should be observed concerning the adminstration of antithrombotic drugs both prior to, and after, neuraxial procedures or those peripheral nerve blocks with higher bleeding risk (deep, noncompressible). These time intervals vary according to the type and dose of anticoagulant drugs, renal function and whether a traumatic puncture has occured. Drug measurements may be used to guide certain time intervals, whilst specific reversal for vitamin K antagonists and dabigatran may also influence these. Ultrasound guidance, drug combinations and bleeding risk scores do not modify the time intervals. In peripheral nerve blocks with low bleeding risk (superficial, compressible), these time intervals do not apply. CONCLUSION: In patients taking antiplatelet or anticoagulant medications, practitioners must consider the bleeding risk both before and after nerve blockade and during insertion or removal of a catheter. Healthcare teams managing such patients must be aware of the risk and be competent in detecting and managing any possible haematomas.

AIM: This study examined the agreement on self-reported Health-Related Quality of Life (HRQOL) between adolescents with burns and their mother's and father's observation at 6 and 18 months after the burn. Moreover, factors potentially influencing discrepancies between the adolescent and proxy reports were examined. METHODS: Children with burns (11-18 years old) and their mother and father were invited to participate. A total of 54 adolescents aged 11 years or older filled out the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire (BOQ). Descriptive and correlational analyses were performed. RESULTS: The physical functioning scores showed to be optimal in almost all participants (99%) and across the three informants. Adolescents reported better functioning than their fathers and mothers on most of the scales. On average the correlations between self-reports and proxy reports were moderate to good. Higher parental traumatic stress scores were linked to less favorable parent-reported burn outcomes. CONCLUSION: Overall, this study showed that a large proportion of the parents had similar views on the adolescents physical functioning, but disparities emerged also, mainly in psychosocial scales. The discrepancies between self- and parent reports should be discussed when they have a role in treatment decisions. Preferably, besides parent-reports, adolescents' self-reports should be included in clinical assessments and treatment decisions, as parental traumatic stress symptoms are a possible factor influencing parental observations.

not available, Rivaroxaban is one of the new oral anticoagulants (NOACs). It has many potential advantages in comparison with Vitamin K Antagonists (VKA). It has a predictable anticoagulant effect and does not theoretically require biological monitoring. It is also characterized by less food and drug interactions. However, due to major risks associated with over- and under-dosage, its optimal use in patients should be carefully followed by health care professionals. The aim of this article is to provide recommendations for pharmacists on the practical use of Xarelto in its different approved indications. This document is adapted from the practical user guide of rivaroxaban which was developed by an independent group of Belgian experts in the field of thrombosis and haemostasis.

Rivaroxaban is one of the new oral anticoagulants (NOACs) (recommended as reference treatments when a long-term anticoagulation is needed). It has many potential advantages in comparison with Vitamin K Antagonists (VKA). It has a predictable anticoagulant effect and does not theoretically require biological monitoring. It is also characterized by less food and drug interactions. However, due to major risks associated with over- and under-dosage, its optimal use in patients should be carefully followed by health care professionals. The aim of this article is to provide recommendations for pharmacists on the practical use of Xarelto® in its different approved indications. This document is adapted from the practical user guide of rivaroxaban which was developed by an independent group of Belgian experts in the field of thrombosis and haemostasis.

Le rivaroxaban (Xarelto®) fait partie des nouveaux anticoagulants oraux. Il présente de nombreux avantages potentiels par rapport aux anti-vitamines K. Il possède un effet anticoagulant prévisible et ne nécessite pas à priori de monitoring biologique régulier. Il se caractérise également par un profil d’interactions médicamenteuses et alimentaires nettement plus favorable. Néanmoins, en raison des risques majeurs associés à des sur- ou sous-dosages de ces produits, leur utilisation optimale par les patients est indispensable. L’objectif de cet article est de proposer au pharmacien des recommandations concises sur l’utilisation pratique du Xarelto® quelle que soit son indication. Ce document est adapté du guide d’utilisation pratique du rivaroxaban qui a fait l’objet d’un consensus d’un groupe indépendant de spécialistes impliqués dans le domaine de la thrombose et de l’hémostase au niveau belge