Subdural spinal haematoma after spinal anaesthesia in a patient taking aspirin

Seow, Kevin; Drummond, Katharine J.

doi:10.1016/j.jocn.2011.03.016

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…It is usually related to anticoagulation (in therapeutic doses), blood dyscrasia, spinal arteriovenous malformations, or is idiopathic (10). There has been no association between low-dose aspirin or prophylactic dose of heparin and subdural hematoma except for cases related to post-spinal anesthesia (16,17). The current case had no history of back trauma.…”

Section: Discussionmentioning

confidence: 68%

Eosinophilic Granulomatosis with Polyangiitis and Spinal Subdural Hematoma: A Case-Based Review of the Literature

Shenavandeh

Eazadnegahdar

Nazarinia

et al. 2018

Iran Red Crescent Med J

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Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as a Churg-Strauss syndrome, is a rare systemic vasculitis. Central nervous system (CNS) involvement is described in rare cases. Acute spinal subdural hematoma (SSDH) is an uncommon condition presented with acute severe, radiating pain in the back area, and symptoms of spinal cord compression. The association of these two rare entities has been rarely reported so far. Case Presentation: A 32-year-old female known case of limited scleroderma for 12 years and EGPA for 6 years with presentation of eosinophilia, high P-ANCA, and skin vasculitis, was admitted to the rheumatology ward of Faghihi hospital related to Shiraz University of Medical Science in Iran (May 2016) due to new necrotizing vasculitis lesions on her hands, dyspnea, bilateral crackles, and eosinophilia. During this hospital admission, while receiving methylprednisolone, low dose aspirin, and prophylactic heparin, she developed severe upper back pain and neck rigidity and in her imaging studies, thoracic spinal subdural hematoma was seen. Conclusions: This article describes a case of EPGA presented with a non-traumatic acute subdural thoracic hematoma in addition to her classic symptoms along with limited scleroderma. This suggests that non-traumatic spontaneous acute spinal subdural hematomas should be considered in manifestations of EPGA and early recognition could be helpful for appropriate management.

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Section: Discussionmentioning

confidence: 68%

Eosinophilic Granulomatosis with Polyangiitis and Spinal Subdural Hematoma: A Case-Based Review of the Literature

Shenavandeh

Eazadnegahdar

Nazarinia

et al. 2018

Iran Red Crescent Med J

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“…[2][3][4] Case reports of subdural hematomas following spinal anesthesia have also questioned ASA's continuation prior to a spinal anesthetic. 157,158 In addition, spinal hematomas have occurred after cervical ESIs in individuals taking non-ASA NSAIDs. 5,159 Other studies examining the performance of lumbar epidurals for pregnancy have not demonstrated an increased risk of bleeding complications with ASA.…”

Section: Procedural Recommendations: Overviewmentioning

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

119

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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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“…1-3 Case reports of subdural hematomas after spinal anesthesia have also questioned aspirin's continuation before a spinal anesthetic. 141,142 In addition, spinal hematomas have occurred after cervical ESIs in individuals taking non-aspirin NSAIDs. 4,143 Other studies examining the performance of lumbar epidurals for pregnancy have not demonstrated an increased risk of bleeding complications with aspirin.…”

Section: Procedural Recommendationsmentioning

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.

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Subdural spinal haematoma after spinal anaesthesia in a patient taking aspirin

Cited by 11 publications

References 18 publications

Eosinophilic Granulomatosis with Polyangiitis and Spinal Subdural Hematoma: A Case-Based Review of the Literature

Eosinophilic Granulomatosis with Polyangiitis and Spinal Subdural Hematoma: A Case-Based Review of the Literature

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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