Neuraxial hematoma and paralysis after enoxaparin administration 3 days after attempted spinal anesthesia for total knee arthroplasty.
A 69-year-old man underwent a total knee arthroplasty. Spinal anesthesia was attempted, but when unsuccessful, a general anesthesia was given. The surgery and rehabilitation were uneventful until postoperative day 3 when a pulmonary embolism was diagnosed. He was placed on enoxaparin at a therapeutic dose that begun more than 72 hours after his attempted spinal. He developed a spinal hematoma and was paralyzed. The literature has no recommendations for using enoxaparin at therapeutic doses after regional anesthesia. There is no previous report to suggest that a patient 72 hours after surgery is still at risk from a neuraxial hematoma.
Bindelglass
David F
DF
The Joint Reconstruction Center at Bridgeport Hospital, Bridgeport, Connecticut, USA.
Rosenblum
David S
DS
D000368:Aged; D000775:Anesthesia, Spinal; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee; D004305:Dose-Response Relationship, Drug; D017984:Enoxaparin / Q000009:adverse effects* / Q000627:therapeutic use; D046748:Hematoma, Epidural, Spinal / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery; D010243:Paralysis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000188:drug therapy; D012307:Risk Factors; D013997:Time Factors; D020246:Venous Thrombosis / Q000517:prevention & control
D000925:Anticoagulants; D017984:Enoxaparin