Hemorrhagic complications associated with regional anesthesia are extremely rare. The fifth edition of the American Society of Regional Anesthesia and Pain Medicine's Evidence-Based Guidelines on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy reviews the published evidence since 2018 and provides guidance to help avoid this potentially catastrophic complication.The fifth edition of the American Society of Regional Anesthesia and Pain Medicine's Evidence-Based Guidelines on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy uses similar methodology as previous editions but is reorganized and significantly condensed. Therefore, the clinicians are encouraged to review the earlier texts for more detailed descriptions of methods, clinical trials, case series and pharmacology. It is impossible to perform large, randomized controlled trials evaluating a complication this rare; therefore, where the evidence is limited, the authors continue to maintain an 'antihemorrhagic' approach focused on patient safety and have proposed conservative times for the interruption of therapy prior to neural blockade. In previous versions, the anticoagulant doses were described as prophylactic and therapeutic. In this version, we will be using 'low dose' and 'high dose,' which will allow us to be consistent with other published guidelines and more accurately describe the dose in the setting of specific patient characteristics and indications. For example, the same 'high' dose may be used in one patient as a treatment for deep venous thrombosis (DVT) and in another patient as prophylaxis for recurrent DVT. Due to the increasing ability to obtain drug-specific assays, we have included suggestions for when ordering these tests may be helpful and guide practice. Like previous editions, at the end of each recommendation the authors have clearly noted how the recommendation has changed from previous editions.

区域麻醉引起的出血性并发症极为罕见。美国区域麻醉和疼痛医学学会第五版关于接受抗血栓或溶栓治疗的患者区域麻醉的循证指南回顾了自2018年以来发表的证据，并提供了帮助避免这种潜在灾难性并发症的指导。美国区域麻醉和疼痛医学学会第五版关于接受抗血栓或溶栓治疗的患者区域麻醉的循证指南使用与以前版本相似的方法，但进行了重组和显著精简。因此，鼓励临床医生回顾早期的文本更详细的描述方法，临床试验，病例系列和药理学。不可能进行大型随机对照试验来评估这种罕见的并发症；因此，在证据有限的情况下，作者继续维持以患者安全为重点的“抗出血”方法，并建议在神经阻断之前中断治疗的保守时间。在以前的版本中，抗凝剂剂量被描述为预防和治疗。在这个版本中，我们将使用“低剂量”和“高剂量”，这将使我们与其他已发表的指南保持一致，并更准确地描述特定患者特征和适应症的剂量。例如，相同的“高”剂量可能用于一名患者治疗深静脉血栓形成（DVT），而用于另一名患者预防复发性DVT。由于获得药物特异性检测的能力日益增强，我们在何时订购这些检测可能有帮助并指导实践时提出了建议。像以前的版本一样，在每个建议的末尾，作者都清楚地指出了该建议与以前的版本有什么不同。