Epidural Hematoma Associated with Enoxaparin

Jm, Hynson; Ja, Katz; Hu, Bueff

doi:10.1097/00000539-199605000-00035

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…Hynson et al described a case where a patient developed a spinal haematoma after epidural anaesthesia in association with prophylactic LMWH and no other risk factor. 8 In contrast to our patient, this patient received a two times per day dose as common in the USA. 8 A possibility to monitor the activity of LMWH is to measure the anti-Xa activity in the laboratory testing.…”

Section: Discussionmentioning

confidence: 71%

Subdural spinal haematoma after epidural anaesthesia

Hasegawa,

Saladin,

Rehli

et al. 2023

BMJ Case Rep

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Epidural anaesthesia is widely used in major thoracic and abdominal surgery for postoperative analgesia. Spinal haematoma after epidural anaesthesia in patients without risk factors is very rare. Most of the reported spinal haematomas arose in the epidural space, whereas the subdural localization seen in this case is very uncommon.We report a case of spinal subdural haematoma after difficult and repeated placement of an epidural catheter for postoperative analgesia. As no sensorimotor deficit of the lower limb arose, we refrained from immediate neurosurgical decompression and the patient recovered fully in the course. Nevertheless, any kind of spinal haematoma is a serious complication we should always be aware of. Prompt detection of clinical symptoms such as sensory or motor deficit is most important. Further diagnostic steps and treatment should not be delayed to avoid permanent neurological deficits.

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Section: Discussionmentioning

confidence: 71%

Subdural spinal haematoma after epidural anaesthesia

Hasegawa,

Saladin,

Rehli

et al. 2023

BMJ Case Rep

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“…In addition, the type of anaesthesia may be affected by anticoagulation. Bleeding and neurological dysfunction may occur during the insertion or removal of a spinal or epidural catheter in an anticoagulated patient [25–27]. Warfarin therapy is a contraindication for regional anaesthesia, such as spinal and epidural [12].…”

Section: Discussionmentioning

confidence: 99%

Management of Warfarin Anticoagulation in Patients with Fractured Neck of Femur

et al. 2011

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Background. Most orthopaedic units do not have a policy for reversal of anticoagulation in patients with hip fractures. The aim of this study was to examine the current practice in a district general hospital and determine difference in the time to surgery, if any, with cessation of warfarin versus cessation and treatment with vitamin K. Methods. A retrospective review of the case notes between January 2005 and December 2008 identified 1797 patients with fracture neck of femur. Fifty seven (3.2%) patients were on warfarin at the time of admission. Patients were divided into 2 groups (A and B). Group A patients (16/57; 28%) were treated with cessation of warfarin only and group B patients (41; 72%) received pharmacological therapy in addition to stopping warfarin. Time to surgery between the two groups was compared. Results. The mean INR on admission was 2.9 (range 1.7–6.5) and prior to surgery 1.4 (range 1.0–2.1). Thirty eight patients received vitamin K only and 3 patients received fresh frozen plasma and vitamin K. The average time to surgery was 4.4 days in group A and 2.4 days in group B. The difference was statistically significant (P < .01). Conclusion. Reversal of high INR is important to avoid significant delay in surgery. There is a need for a national policy for reversing warfarin anticoagulation in patients with hip fractures requiring surgery. Vitamin K is safe and effective for anticoagulation reversal in hip fracture patients.

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“…LMWH have a dose-dependent bleeding potential [12,13]. It is interesting to note that in North America the approved dose of enoxaparin is 30 mg twice daily while in Europe a 40 mg single daily dose is used [4,5,9,14].…”

Section: Discussionmentioning

confidence: 99%

“…This case used European practice guidelines for the use of LMWH. The use of low dose LMWH does not usually require monitoring of the anticoagulant effect because of the predictability of its effect [12,13]. However, the use of high dose LMWH in elderly patients with multisystem disease probably requires laboratory monitoring [12].…”

Section: Discussionmentioning

confidence: 99%

“…We deduce epidural hematoma from impaired hemostasis due to continuative enoxaparin therapy in the postoperative period. The American Society of Regional Anesthesia (ASRA) recommended that one must wait at least 10 to 12 hours after the last dose of LMWH to withdraw the catheter and then wait another 2 hours before giving the next LMWH dose [1,8,9,13]. In this case, the epidural catheter was removed 16 hours after the first dose of LMWH and the second dose of LMWH was administered 2 hours after catheter removal.…”

Section: Discussionmentioning

confidence: 99%

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Spinal epidural hematoma after epidural anesthesia in a patient receiving enoxaparin -A case report-

Han

Chung

Hahn

2010

Korean J Anesthesiol

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Spinal epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. Enoxaparin sodium is a low molecular weight heparin (LMWH) for use in preventing deep venous thrombosis in patients undergoing total hip arthroplasty and total knee arthroplasty. Hemorrhage is an uncommon but documented adverse reaction when using LMWH. We report a case of epidural hematoma after lumbar epidural anesthesia in a patient who administered enoxaparin in perioperative period.

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Epidural Hematoma Associated with Enoxaparin

Cited by 12 publications

References 20 publications

Subdural spinal haematoma after epidural anaesthesia

Subdural spinal haematoma after epidural anaesthesia

Management of Warfarin Anticoagulation in Patients with Fractured Neck of Femur

Spinal epidural hematoma after epidural anesthesia in a patient receiving enoxaparin -A case report-

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