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

Abstract

Balancing the risks of stent occlusion and epidural bleeding, bedside impedance aggregometry helped to identify the optimum time window for epidural catheter removal with the lowest bleeding risk in this patient.

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

“…Devices such as a platelet function analyzers (PFA) can detect the effects of the platelet inhibitors ASA, clopidogrel, and GpIIb/IIIa antagonists, and also the newer direct ADP receptor antagonists. The PFA can, e.g., be used for assessment of the optimal timing of epidural catheter removal, 145 and requires trained personnel. it has a poor prediction of surgical bleeding with sensitivity and a positive predictive value similar to those of the platelet count 146 …”

Epidural Removal After Perioperative Myocardial Infarction and Coronary Stent Placement

“…1,2 Osteoporosis pseudoglioma usually presents with recurrent long-bone fractures, reductions in bone mineral density, compression fractures, and kyphoscoliosis. 3 Like many other patients with this syndrome, our patient had severe symptomatic osteoporosis with an extensive history of repeated long-bone fractures that required multiple surgical interventions.…”

“…Three previous case reports have described similar situations, except medications were held until laboratory data normalized, resulting in 1 indwelling epidural catheter for 4 weeks. [3][4][5] This case differs because it demonstrates that early assessment may permit epidural catheter removal without cessation of antiplatelet therapy.…”

ROTEM and multiplate – a suitable tool for POC?

“…Bergman et al. reported the use of MEA for guiding the removal of an epidural catheter in a patient requiring dual platelet inhibition (acetylsalicylic acid plus clopidogrel) [55]. Weber et al.…”