Uncomplicated Removal of Epidural Catheters in 4365 Patients With International Normalized Ratio Greater Than 1.4 During Initiation of Warfarin Therapy

Abstract

Our series of 4365 patients had uncomplicated removal of epidural catheters despite INRs ranging from 1.5 to 5.9. Removal was only during initiation of warfarin therapy (up to approximately 50 hrs after warfarin intake) when several vitamin K factors are likely to still be adequate for hemostasis.

Effect of thoracic epidural analgesia on clinical outcomes following transapical transcatheter aortic valve implantation

“…However, several studies have shown that TEA is safe in this setting,8–11 18 and recent studies have also suggested that anticoagulant therapy is safe in the presence of, or upon removal of, an epidural catheter 19 20. Consistent with these previous reports, we observed no local complications associated with TEA despite the use of antithrombotic therapy both before and after insertion of the epidural catheter.…”

Incidence, Predictive Factors, and Prognostic Value of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Implantation

“…However, patients undergoing TAVI nowadays are at high risk for thromboembolism in case of atrial arrhythmia (median CHADS2 score of the study population of 3), and a more aggressive antithrombotic treatment should probably be implemented in these cases. Also, although the guidelines recommend a 24-h delay for initiating anticoagulation in the presence of an epidural catheter (16), some recent studies have shown the safety of anticoagulant therapy in the presence of or when removing an epidural catheter (31,32). Finally, although double antiplatelet therapy with aspirin and clopidogrel has been empirically recommended following TAVI, future randomized studies will have to evaluate the more appropriate antithrombotic treatment following these procedures and the potential role for systematic anticoagulant therapy either with warfarin or direct thrombin inhibitors in this setting.…”

Incidence of spinal haematoma after epidural puncture

“…[1][2][3][4]6,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Case reports of spinal haematoma after epidural analgesia are rare. 28 In fact, there is no report in conjunction with anticoagulation in the obstetric population.…”