title: Atypical presentation of an epidural hematoma in a patient receiving aspirin and low molecular weight heparin. Was epidural analgesia the right choice?
abstract: A case of postoperative epidural hematoma with an atypical presentation and an excellent outcome in an 80 year-old woman who received both prophylactic aspirin and enoxaparin following a primary total knee arthroplasty, is presented. She developed lower limb neurological symptoms, fully recovered, and then deteriorated again. The hematoma was surgically evacuated, resulting in full neurological recovery. Epidural analgesia may not be the best choice for pain management in patients who require the combined use of aspirin and low-molecular weight heparin postoperatively.
authors.affiliation: Department of Anesthesia and Pain Management, Mount Sinai Hospital, Ontario, Canada.
authors.forename: Shilpa V
authors.initials: SV
authors.lastname: Kasodekar
authors.forename: Eric
authors.initials: E
authors.lastname: Goldszmidt
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Davies
mesh_terms: D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000139:chemically induced*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011182:Postoperative Care; D016896:Treatment Outcome
chemical_list: D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin