Spinal Epidural Hematoma Associated with Epidural Anesthesia: Complications of Systemic Heparinization in Patients Receiving Peripheral Vascular Thrombolytic Therapy

Dickman, Curtis A.; Shedd, Steven A.; Spetzler, Robert F.; Shetter, Andrew G.; Sonntag, Volker K. H.

doi:10.1097/00000542-199005000-00028

Cited by 104 publications

(25 citation statements)

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“…Nontraumatic spinal SDH is a known complication of lumbar puncture [1] and may be associated with hemorrhagic disorders [2], anticoagulation therapy [2], spinal surgery, tumors [4], vascular malformations [5], and spinal or epidural anesthesia [3]. Posttraumatic spinal SDH is very uncommon with only 10 cases reported in the literature ( Table 1) The mechanisms of spinal SDH are still debated.…”

Section: Discussionmentioning

confidence: 99%

“…Spinal subdural hematoma (SDH) is a rare and potentially life threatening condition associated with trauma, lumbar puncture [1], hemorrhagic disorder, anticoagulant therapy [2], spinal surgery, tumor, vascular malformations, and spinal or epidural anesthesia [3]. Traumatic spinal SDH is more uncommon with only 10 reported cases in the literature (Table 1).…”

Section: Introductionmentioning

confidence: 99%

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Traumatic lumbar spinal subdural hematoma

Gordon

Kimball

Arthur

2014

Interdisciplinary Neurosurgery

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a b s t r a c tSpinal subdural hematoma (SDH) is a rare and potentially life-threatening condition associated with trauma, lumbar puncture, hemorrhagic disorder, anticoagulant therapy, spinal surgery, tumor, vascular malformations, and spinal or epidural anesthesia. Traumatic SDH is even more uncommon than other forms of SDH with only 10 reported cases in the literature. Following a punch to the head and loss of consciousness, a 35-year-old man reported headaches, right-sided tinnitus, and dull ache behind both eyes. He also experienced sacral pain with stiffness that was exacerbated by movement. MRI showed an isolated lumbar SDH causing mild stenosis. On follow-up, the patient still experienced right-sided tinnitus and bilateral sacral radiculopathy and was prescribed prednisone with repeat MRI at 6weeks. At the next follow-up, the patient's radiculopathy had resolved completely. Our case illustrates rapid resolution of a posttraumatic spinal SDH after treatment with oral corticosteroids. Recognition of blood products on MRI is vital to diagnosis and expedient treatment. There is agreement that prompt laminectomy with evacuation of SDH should be performed before permanent damage to the spinal cord occurs. Including our patient, 4 of 11 reported cases of thoracic or lumbar SDH resolved with conservative treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Traumatic lumbar spinal subdural hematoma

Gordon

Kimball

Arthur

2014

Interdisciplinary Neurosurgery

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“…5,6 The risk of epidural hematoma formation after epidural catheterization or catheter removal is increased in patients with coagulation disorders and those treated with anticoagulants. [7][8][9] Furthermore, combination of antiplatelet drugs, like ASA and clopidogrel, significantly increases bleeding time and evokes more bleeding complications than either drug alone. 10 The occurrence of stent occlusion after platelet transfusion in a patient with a normal platelet count is unknown, and considering this, we did not transfuse the patient.…”

Section: Discussionmentioning

confidence: 99%

Uneventful Removal of an Epidural Catheter Guided by Impedance Aggregometry in a Patient With Recent Coronary Stenting and Treated With Clopidogrel and Acetylsalicylic Acid

Bergmann

Kienbaum

Görlinger

2007

Regional Anesthesia and Pain Medicine

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“…[238][239][240][241][242][243][244] There are also cases of spinal hematoma in patients who had neuraxial procedures and had subsequent thrombolytic therapy. [245][246][247] In some case reports, the patients were also given heparin. The risk of spinal hematoma in patients who receive thrombolytic therapy is not well defined because of the understandable lack of prospective studies.…”

Section: Fibrinolytic Agentsmentioning

confidence: 99%

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

Narouze

Benzon

Provenzano³

et al. 2015

Regional Anesthesia and Pain Medicine

262

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Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine. The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.

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Spinal Epidural Hematoma Associated with Epidural Anesthesia: Complications of Systemic Heparinization in Patients Receiving Peripheral Vascular Thrombolytic Therapy

Cited by 104 publications

References 0 publications

Traumatic lumbar spinal subdural hematoma

Traumatic lumbar spinal subdural hematoma

Uneventful Removal of an Epidural Catheter Guided by Impedance Aggregometry in a Patient With Recent Coronary Stenting and Treated With Clopidogrel and Acetylsalicylic Acid

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

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