Intrathecal Bleeding After the Intraoperative Use of Heparin and Urokinase During Continuous Spinal Anesthesia

Rabito, Sara F.; Ahmed, Salahuddin; Feinstein, Lowell; Winnie, Alon P.

doi:10.1097/00000539-199602000-00034

Cited by 13 publications

(5 citation statements)

References 7 publications

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“…Five cases appeared in the literature [69][70][71][72][73] ; 1 additional case was reported through the MedWatch system. (The MedWatch program was initiated in 1993.…”

Section: Pharmacology Of Fibrinolytics/thrombolyticsmentioning

confidence: 99%

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

Horlocker

Vandermeuelen

Kopp

et al. 2018

Regional Anesthesia and Pain Medicine

746

106

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“…Five cases appeared in the literature [69][70][71][72][73] ; 1 additional case was reported through the MedWatch system. (The MedWatch program was initiated in 1993.…”

Section: Pharmacology Of Fibrinolytics/thrombolyticsmentioning

confidence: 99%

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

Horlocker

Vandermeuelen

Kopp

et al. 2018

Regional Anesthesia and Pain Medicine

746

106

View full text Add to dashboard Cite

“…[259][260][261][262][263][264][265] There are also cases of spinal hematoma in patients who had neuraxial procedures and had subsequent thrombolytic therapy. [266][267][268][269] 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 (Second Edition)

Narouze

Benzon

Provenzano³

et al. 2017

Regional Anesthesia and Pain Medicine

118

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The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation. The first guidelines specific to interventional spine and pain procedures were published in 2015. Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines. 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 because 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. This publication is intended as a living document to be updated periodically with consideration of new evidence.

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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

267

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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.

show abstract

Intrathecal Bleeding After the Intraoperative Use of Heparin and Urokinase During Continuous Spinal Anesthesia

Cited by 13 publications

References 7 publications

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition)

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

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