Coagulopathy either from the use of anticoagulant, antiplatelet, or thrombolytic medications or from underlying medical conditions is considered one of the major risk factors for epidural hematoma formation related to epidural catheter placement or removal. The American Society of Regional Anesthesia and Pain Medicine (ASRA) has laid down guidelines regarding timing of neuraxial blockade or removal of neuraxial catheters in patients receiving either antithrombotic or thrombolytic therapy. We present a case of acute onset of paraplegia because of an epidural hematoma following removal of the epidural catheter in a patient who was given the first dose of antithrombotic therapy after the removal of the epidural catheter as per the ASRA guidelines. The epidural hematoma was diagnosed with an urgent magnetic resonance imaging, and the patient was urgently taken up for surgical evacuation of the hematoma. The patient made full recovery over 1 week period.
Epidural Catheters, Anticoagulation and the risk of Spinal Hematoma: A Review of Literature. Internet J Orthoped Surg 2007;6.
Gulur P, Tsui B, Pathak R, Koury KM, Lee H. Retrospective analysis of the incidence of epidural haematoma in patients with epidural catheters and abnormal coagulation parameters. Br J Anaesth 2015;114:808-11.
Ruppen W, Derry S, McQuay H, Moore RA. Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology 2006;105:394-9.
Cook TM, Counsell D, Wildsmith JA; Royal College of Anaesthetists Third National Audit Project. Major complications of central neuraxial block: Report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth 2009;102:179-90.
Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American society of regional anesthesia and pain medicine evidence-based guidelines (Third edition). Reg Anesth Pain Med 2010;35:64-101.
Horlocker T, Vandermeuelen E, Kopp S, Gogarten W, Leffert L, Benzon H, et al. Regional anaesthesia in the patient receiving antithrombotic or thrombolytic therapy. Reg Anesth Pain Med 2018;43:263-309.
Narouze S, Benzon HT, Provenzano DA, Buvanendran A, De Andres J, Deer TR, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: Guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med 2015;40:182-212.
Gayton JC, Sensiba P, Imbrogno BF, Venkatarayappa I, Tsatalis J, Prayson MJ, et al. The effects of magnetic resonance imaging on surgical staples: An experimental analysis. J Trauma 2011;70:1279-81.
Gill A, Shellock FG. Assessment of MRI issues at 3-Tesla for metallic surgical implants: Findings applied to 61 additional skin closure staples and vessel ligation clips. J Cardiovasc Magn Reson 2012;14:3.
Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA, et al. Surgical management of spinal epidural hematoma: Relationship between surgical timing and neurological outcome. J Neurosurg 1995;83:1-7.