Spinal Epidural Hematoma Following Epidural Catheter Removal in a Patient with Postoperative Urgent Coronary Intervention and Intra-Aortic Balloon Pumping (IABP): A Case Report

Am J Case Rep, 2019 · DOI: 10.12659/AJCR.917716 · Published: September 13, 2019

Cardiovascular Science Anesthesiology Research Methodology & Design

Simple Explanation

This case report describes a 72-year-old male who developed a spinal epidural hematoma after epidural catheter removal following urgent coronary intervention. The patient had undergone surgery and subsequently experienced a heart attack, requiring antiplatelet and anticoagulation therapy, complicating the epidural catheter removal. The authors conclude that in patients needing urgent antithrombotic therapy for coronary issues, epidural catheter removal should be delayed until the antithrombotic measures are discontinued and platelet counts recover.

Study Duration

Not specified

Participants

Male, 72 years old

Evidence Level

Case Report

Key Findings

1
The patient developed motor paralysis and sensory loss hours after the epidural catheter was removed.
2
Emergency MRI revealed a spinal epidural hematoma compressing the spinal cord.
3
Surgical intervention and rehabilitation provided only slight improvement in symptoms.

Research Summary

This case report highlights the risk of spinal epidural hematoma after epidural catheter removal in patients receiving urgent antithrombotic therapy following coronary intervention. The patient's low platelet count and ongoing anticoagulation therapy at the time of catheter removal likely contributed to the hematoma. The authors emphasize the importance of delaying epidural catheter removal until antithrombotic therapies are discontinued and platelet counts have recovered.

Practical Implications

Clinical Practice

Delay epidural catheter removal in patients requiring urgent antithrombotic therapy for coronary intervention until anticoagulation is stopped and platelet counts recover.

Risk Assessment

Carefully assess the risk of spinal hematoma in patients with combined antiplatelet and anticoagulation therapy.

Monitoring

Closely monitor patients for neurological symptoms after epidural catheter removal, especially in the context of antithrombotic therapy.