Spinal Epidural Hematoma Detected by Lumbar Epidural Puncture

Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

“…Thus, CRF is a definite risk factor for spinal haemorrhage, 3 illustrated by two case reports of post‐CNB SHs, where CRF was the only recognized risk factor 114,115 . There are also two cases of CRF with clopidogrel medication, interrupted 1 week before the CNB, and given LMWH peri‐operatively, 82,83 and one additional case with aspirin medication, intraoperative heparinization, and dextran infusion, apart from his renal disease 116 . Although only parts of clopidogrel and rivaroxaban are eliminated by the kidneys, LMWH, fondaparinux, and dabigatran are fully excreted by the kidneys; these drugs may accumulate in patients with CRF, contributing to a higher risk of spinal bleeding from CNB 113…”

Bleeding Risk in Interventional Pain Practice: Assessment, Management, and Review of the Literature

“…The presence of even mild liver dysfunction may be a causal factor in procedure-related bleeding. Hepatic dysfunc-tion with accompanied portal hypertension may cause epidural venous congestion and increase the likelihood of bleeding (184)(185)(186). More advanced liver disease increases the risk of neuraxial hematomas following regional procedures: reduced production of clotting factors, portal hypertension induced epidural venous engorgement, and hypersplenisminduced platelet sequestration (67,187).…”

“…Spinal epidural hematomas occur more often than expected and many remain asymptomatic (185,186). Thirteen to fifteen percent of patients may not have identifiable risk factors (20,208).…”