Spinal epidural hematoma following epidural catheter removal during antiplatelet therapy with cilostazol

Kaneda, Toru; Urimoto, Genya; Suzuki, Toshiyasu

doi:10.1007/s00540-008-0623-5

Cited by 27 publications

(11 citation statements)

References 10 publications

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“…We examined these etiological factors individually to detect special features. We did not define any groups under the term "spontaneous" because, in the literature, this term is used to describe patients with idiopathic SEH 27 as well as those with coagulopathy, 37 female patients who were pregnant, 16 patients undergoing treatment with antiplatelet drugs, 38 those with vascular malformations, 25,27 or patients with a combination of these conditions, 3 leading to some confusion in terminology. We agree with Lonjon et al 41 that the definition "spontaneous spinal epidural hematoma," which is often used in the literature, is ambiguous, but the expression "non-traumatic spinal epidural hematoma" used by those authors is equally confusing, as it does not exclude patients with bleeding disorders or vascular malformation.…”

mentioning

confidence: 99%

Spinal epidural hematomas: personal experience and literature review of more than 1000 cases

Domenicucci¹,

Mancarella²,

Santoro³

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEThe goal of this study was to identify factors that contribute to the formation of acute spinal epidural hematoma (SEH) by correlating etiology, age, site, clinical status, and treatment with immediate results and long-term outcomes.METHODSThe authors reviewed their series of 15 patients who had been treated for SEH between 1996 and 2012. In addition, the authors reviewed the relevant international literature from 1869 (when SEH was first described) to 2012, collecting a total of 1010 cases. Statistical analysis was performed in 959 (95%) cases that were considered valid for assessing the incidence of age, sex, site, and clinical status at admission, correlating each of these parameters with the treatment results. Statistical analysis was also performed in 720 (71.3%) cases to study the incidence of etiological factors that favor SEH formation: coagulopathy, trauma, spinal puncture, pregnancy, and multifactorial disorders. The clinical status at admission and long-term outcome were studied for each group. Clinical status was assessed using the Neuro-Grade (NG) scale.RESULTSThe mean patient age was 47.97 years (range 0–91 years), and a significant proportion of patients were male (60%, p < 0.001). A bimodal distribution has been reported for age at onset with peaks in the 2nd and 6th decades of life. The cause of the SEH was not reported in 42% of cases. The etiology concerned mainly iatrogenic factors (18%), such as coagulopathy or spinal puncture, rather than noniatrogenic factors (29%), such as genetic or metabolic coagulopathy, trauma, and pregnancy. The etiology was multifactorial in 11.1% of cases. The most common sites for SEH were C-6 (n = 293, 31%) and T-12 (n = 208, 22%), with maximum extension of 6 vertebral bodies in 720 cases (75%). At admission, 806 (84%) cases had moderate neurological impairment (NG 2 or 3), and only lumbar hematoma was associated with a good initial clinical neurological status (NG 0 or 1). Surgery was performed in 767 (80%) cases. Mortality was greater in patients older than 40 years of age (9%; p < 0.01). Sex did not influence any of these data (p > 0.05).CONCLUSIONSFactors that contribute to the formation of acute SEH are iatrogenic, not iatrogenic, or multifactorial. The treatment of choice is surgery, and the results of treatment are influenced by the patient’s clinical and neurological status at admission, age, and the craniocaudal site.

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mentioning

confidence: 99%

Spinal epidural hematomas: personal experience and literature review of more than 1000 cases

Domenicucci¹,

Mancarella²,

Santoro³

et al. 2017

Journal of Neurosurgery: Spine

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“…85,86 One case report described a spinal epidural hematoma after epidural catheter removal in an individual with a low platelet count who had been taking cilostazol following vascular surgery. 87 Limited data exist evaluating the risk of perioperative surgical bleeding with cilostazol, and no standard perioperative guidelines are available. 88 If the medication is discontinued, even after continuous dosing, at 50 hours (approximately 5 half-lives) less than 5% of the drug remains in the plasma, and improvements in platelet aggregation have been demonstrated.…”

Section: Dipyridamole Combined With Asamentioning

confidence: 99%

“…88 If the medication is discontinued, even after continuous dosing, at 50 hours (approximately 5 half-lives) less than 5% of the drug remains in the plasma, and improvements in platelet aggregation have been demonstrated. 84,87 Cardiac and Cerebrovascular Risks Associated With the Discontinuation of ASA In the United States, a significant number of individuals (>50 million) take ASA for prevention of cardiovascular events. 89 When individuals are taking ASA, it is important to understand whether utilization is for primary or secondary prophylaxis.…”

Section: Dipyridamole Combined With Asamentioning

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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“…79,80 One case report described a spinal epidural hematoma after epidural catheter removal in an individual with a low platelet count that had been taking cilostazol after vascular surgery. 81 Limited data exist evaluating the risk of perioperative surgical bleeding with cilostazol and no standard perioperative guidelines are available. 82 If the medication is discontinued, even after continuous dosing, at 50 hours (approximately 5 half-lives) less than 5% of the drug remains in the plasma and improvements in platelet aggregation have been demonstrated.…”

Section: Dipyridamole Combined With Aspirinmentioning

confidence: 99%

“…82 If the medication is discontinued, even after continuous dosing, at 50 hours (approximately 5 half-lives) less than 5% of the drug remains in the plasma and improvements in platelet aggregation have been demonstrated. 78,81 Cardiac and Cerebrovascular Risks Associated With the Discontinuation of Aspirin…”

Section: Dipyridamole Combined With Aspirinmentioning

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

266

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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.

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Spinal epidural hematoma following epidural catheter removal during antiplatelet therapy with cilostazol

Cited by 27 publications

References 10 publications

Spinal epidural hematomas: personal experience and literature review of more than 1000 cases

Spinal epidural hematomas: personal experience and literature review of more than 1000 cases

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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