title: [Removal of epidural catheter under dual antiplatelet therapy following acute coronary syndrome : scenario without special consideration to the current guidelines on epidural regional anesthesia].
abstract: This article reports the case of a patient who developed acute coronary syndrome while receiving postoperative pain treatment via an epidural catheter (EC). Platelet function testing was performed before removal of the EC to assess the bleeding risk under ongoing dual antiplatelet therapy. Platelet function testing showed low responsiveness to clopidogrel and acetylsalicylic acid (ASS). The EC was removed uneventfully and clopidogrel was subsequently replaced by prasugrel and platelet function showed improved depression of thrombocyte aggregation. Possible reasons for low responsiveness to clopidogrel and ASS, such as drug-drug interactions with proton pump inhibitors and genetic factors are discussed.
authors: Klinik für Anästhesiologie und operative Intensivmedizin, Krankenhaus Köln-Merheim, Lehrstuhl für Anästhesiologie II der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Deutschland. limperu@kliniken-koeln.de
authors: U
authors: U
authors: Limper
authors: J
authors: J
authors: Lynch
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000628:therapy*; D015360:Analgesia, Epidural / Q000379:methods*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D002404:Catheterization / Q000379:methods*; D000077144:Clopidogrel; D013505:Digestive System Surgical Procedures; D004347:Drug Interactions; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D010879:Piperazines / Q000627:therapeutic use; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride; D012306:Risk; D013876:Thiophenes / Q000627:therapeutic use; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin