title: A case of late epidural hematoma in a patient on clopidogrel therapy postoperatively: when is it safe to resume antiplatelet agents?
abstract: BACKGROUND
  The use of antiplatelet agents after coronary artery stent placement is currently recommended to prevent coronary stent obstruction. These patients may have concurrent disabling spinal stenosis and require spinal decompression. Resuming antiplatelet agents as soon as possible after spinal surgery is recommended.
  
  
  OBJECTIVE
  To describe a unique case of late postoperative epidural hematoma occurring with the use of clopidogrel.
  
  
  METHODS
  A case report and review of the literature.
  
  
  METHODS
  The hospital chart, history, physical examination, and imaging of a single patient were reviewed.
  
  
  RESULTS
  A 59-year-old man underwent spinal decompression and fusion for neurogenic claudication with lumbar spinal stenosis and spondylolisthesis while managed on clopidogrel for prevention of thrombosis after cardiac stent placement. He developed a symptomatic epidural hematoma 12 days postoperatively, well outside the usual time frame for this complication. The patient was closely monitored, and lumbar radiculopathy resolved over the ensuing days.
  
  
  CONCLUSIONS
  After spinal surgery and resumption of antiplatelet therapy, the physician needs to maintain vigilance in observing patients for late postoperative complications such as epidural hematoma, which could have catastrophic consequences if not recognized in a timely manner.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Palo Alto, CA 94063-6342, USA.
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Carragee
authors.forename: S Raymond
authors.initials: SR
authors.lastname: Golish
authors.forename: Gaetano J
authors.initials: GJ
authors.lastname: Scuderi
mesh_terms: D000077144:Clopidogrel; D019299:Decompression, Surgical / Q000009:adverse effects*; D046748:Hematoma, Epidural, Spinal / Q000209:etiology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013123:Spinal Fusion / Q000009:adverse effects*; D013130:Spinal Stenosis / Q000601:surgery; D013168:Spondylolisthesis / Q000601:surgery; D015607:Stents; D013927:Thrombosis / Q000188:drug therapy / Q000517:prevention & control*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine