title: Spontaneous spinal epidural hematoma: an urgent complication of adding clopidogrel to aspirin therapy.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hong-Joo
authors.initials: HJ
authors.lastname: Moon
authors.forename: Joo Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Jong-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Taek-Hyun
authors.initials: TH
authors.lastname: Kwon
authors.forename: Hung-Seob
authors.initials: HS
authors.lastname: Chung
authors.forename: Youn-Kwan
authors.initials: YK
authors.lastname: Park
mesh_terms: 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
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin