Spontaneous spinal epidural hematoma: an urgent complication of adding clopidogrel to aspirin therapy.
We report a 56-year-old patient who had been taking antihypertensive medication in combination with prophylactic aspirin for 19 years who was diagnosed with stable angina with significant coronary artery stenosis on angiography. He was treated with drug-eluting coronary stent placement. Clopidogrel was added to the previous treatment regimen after stent placement. He visited the emergency room with complaints of severe back pain accompanied by radiculopathy and left leg weakness. The patient had an excellent outcome after immediate diagnosis by MRI and emergent evacuation of spontaneous spinal epidural hematoma (SSEH). The present case is interesting because it is the first case in spine which corresponds to the findings of MATCH study that bleeding tendency would be raised by dual antiplatelet treatment (aspirin+clopidogrel). With the popularity of antiplatelet medications, physicians should be aware of this critical side effect and provide urgent treatment. Furthermore, we should be cautious when we prescribe clopidogrel in addition to aspirin because it could cause bleeding complications like SSEH.
Moon
Hong-Joo
HJ
Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Kim
Joo Han
JH
Kim
Jong-Hyun
JH
Kwon
Taek-Hyun
TH
Chung
Hung-Seob
HS
Park
Youn-Kwan
YK
D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D000077144:Clopidogrel; D023921:Coronary Stenosis / Q000188:drug therapy / Q000601:surgery; D019299:Decompression, Surgical; D004347:Drug Interactions; D046748:Hematoma, Epidural, Spinal / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery; D015607:Stents; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin