Delphi Consensus Recommendations for Neuraxial Anesthesia in Adults With Platelet Disorders and Coagulation Defects: Communication From the ISTH SSC Subcommittee on Von Willebrand Factor

J Thromb Haemost . 2025;23:2039–2049. doi: 10.1016/j.jtha.2025.01.019. Neuraxial anesthesia (NA) can include spinal, epidural, or combined spinal-epidural anesthesia and offers many benefits compared to general anesthesia, depending on the context. For the obstetric population, it can be used during labor to reduce pain and increase patient satisfaction. A rare (1:200,000 in obstetrics) and serious side effect of NA is spinal-epidural hematoma (SEH); this condition can lead to irreversible neurologic injury, and thus the risk should be mitigated as much as possible. Risk of SEH is increased in patients on antithrombotic therapy, with bleeding disorders, and with epidural anesthesia. There are currently no comprehensive recommendations for NA use in patients with pre-existing coagulation defects or platelet disorders, so this Delphi study was designed to create consensus-based recommendations for clinicians delineating treatment thresholds for the use of NA in adults with these conditions. Recommendations in this study include hemostatic laboratory thresholds for safe administration of spinal and epidural anesthesia as well as removal of epidural catheters for individuals with immune thrombocytopenia (ITP), gestational thrombocytopenia, thrombocytopenia associated with hypertensive disorders of pregnancy, von Willebrand disease (VWD), mild and severe inherited platelet function disorders (IPFDs), factor VII deficiency (FVII), hemophilia A and B, factor XI deficiency (FXI), factor XIII deficiency (FXIII), and fibrinogen dysfunction or deficiency.