Epidural Hematoma after Epidural Steroid Injection in a Patient Withholding Enoxaparin per Guidelines

Ain, Robert J.; Vance, Matthew B.

doi:10.1097/00000542-200503000-00048

Cited by 33 publications

(23 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The American Society of Regional Anesthesia (ASRA) guidelines for neuraxial analgesia are commonly followed to reduce the risk of neuraxial hematoma formation following SCS lead placement. The ASRA guidelines stratify perioperative thromboembolism with bleeding in anticoagulated patients as a risk, and despite this, spinal hematomas following neuraxial interventions continue to occur . Recently, Manchikanti et al.…”

Section: Biologic Complicationsmentioning

confidence: 99%

The Appropriate Use of Neurostimulation: Avoidance and Treatment of Complications of Neurostimulation Therapies for the Treatment of Chronic Pain

Deer¹,

Mekhail

Provenzano³

et al. 2014

Neuromodulation: Technology at the Neural Interface

163

182

View full text Add to dashboard Cite

Section: Biologic Complicationsmentioning

confidence: 99%

The Appropriate Use of Neurostimulation: Avoidance and Treatment of Complications of Neurostimulation Therapies for the Treatment of Chronic Pain

Deer¹,

Mekhail

Provenzano³

et al. 2014

Neuromodulation: Technology at the Neural Interface

163

182

View full text Add to dashboard Cite

“…Two cases of SEH have occurred after epidural steroid injections despite stopping warfarin at least 5 d before (Ain & Vance, 2005; Xu et al , 2009). Both were elderly females who had received therapeutic doses of enoxaparin once warfarin was stopped.…”

Section: Oral Anticoagulantsmentioning

confidence: 99%

“…Both were elderly females who had received therapeutic doses of enoxaparin once warfarin was stopped. One also had renal impairment (Ain & Vance, 2005).…”

Section: Oral Anticoagulantsmentioning

confidence: 99%

Managing anticoagulated patients during neuraxial anaesthesia

Green

Machin

2010

Br J Haematol

View full text Add to dashboard Cite

SummaryThe widespread use of central neuraxial block (CNB) and the prevalence of anticoagulation for different indications have led to an inevitable overlap between the two. The most serious complication of CNB in anticoagulated patients is the risk of spinal/epidural haematoma. Performing CNB in these patients is a complex decision that should take into account the twin risks of bleeding and venous/arterial thrombosis if anticoagulation therapies were to be stopped. Various guidelines have been issued to achieve normal haemostasis and thus allow safe administration of CNB. However, the evidence base for many such recommendations is weak, relying mainly on case reports, small studies and pharmacokinetics of the drugs. Given these limitations it is crucial to fully assess individual risk factors and understand anticoagulant pharmacokinetics in order to appropriately set time intervals for catheter insertion/removal. This paper will review traditional and newer anticoagulation/ antiplatelet therapies with a view to improving the management of anticoagulated patients undergoing CNB.

show abstract

“…The second case occurred in an 85-year-old woman presenting for epidural steroid injection. 108 She was taking warfarin for chronic atrial fibrillation and a St. Jude aortic valve. Warfarin was discontinued 6 days before the procedure (INR = 1.2), and she had received bridge therapy with enoxaparin 1 mg/kg every 12 hrs, with her last dose more than 24 hrs before the injection.…”

Section: Reports Of Spinal Hematoma Since the 2003 Asra Consensus Conmentioning

confidence: 99%

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

Horlocker

Wedel²,

Rowlingson

et al. 2010

Regional Anesthesia and Pain Medicine

1,186

132

View full text Add to dashboard Cite

The actual incidence of neurologic dysfunction resulting from hemorrhagic complications associated with neuraxial blockade is unknown. Although the incidence cited in the literature is estimated to be less than 1 in 150,000 epidural and less than 1 in 220,000 spinal anesthetics, recent epidemiologic surveys suggest that the frequency is increasing and may be as high as 1 in 3000 in some patient populations.Overall, the risk of clinically significant bleeding increase with age,associated abnormalities of the spinal cord or vertebral column, the presence of an underlying coagulopathy, difficulty during needle placement,and an indwelling neuraxial catheter during sustained anticoagulation( particularly with standard heparin or low-molecular weight heparin). The need for prompt diagnosis and intervention to optimize neurologic outcome is also consistently reported. In response to these patient safety issues, the American Society of Regional Anesthesia and Pain Medicine (ASRA) convened its Third Consensus Conference on Regional Anesthesia and Anticoagulation. Practice guidelines or recommendations summarize evidence-based reviews. However, the rarity of spinal hematoma defies a prospective randomized study, and there is no current laboratory model. As a result,the ASRA consensus statements represent the collective experience of recognized experts in the field of neuraxial anesthesia and anticoagulation. These are based on case reports, clinical series, pharmacology,hematology, and risk factors for surgical bleeding. An understanding of the complexity of this issue is essential to patient management.

show abstract

Epidural Hematoma after Epidural Steroid Injection in a Patient Withholding Enoxaparin per Guidelines

Cited by 33 publications

References 0 publications

The Appropriate Use of Neurostimulation: Avoidance and Treatment of Complications of Neurostimulation Therapies for the Treatment of Chronic Pain

The Appropriate Use of Neurostimulation: Avoidance and Treatment of Complications of Neurostimulation Therapies for the Treatment of Chronic Pain

Managing anticoagulated patients during neuraxial anaesthesia

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

Contact Info

Product

Resources

About