title: Safe removal of epidural catheter--a dilemma, in patients who are started on dual anti platelet therapy postoperatively for acute coronary syndrome--a case report.
abstract: Epidural catheter insertion or removal in patients receiving antiplatelet therapy for acute coronary syndrome poses a high risk for epidural hematoma. Though practice guidelines suggest stopping clopidogrel for at least 7 days before such intervention. Withholding anti-platelet drugs for such a long duration represents a great risk to these patients. We present a case of a 53 year old male patient who underwent an exploratory laparotomy. He had an epidural catheter inserted for analgesia. He developed acute myocardial infarction on the first postoperative day, which was treated with dual antiplatelet therapy and percutaneous coronary angioplasty. The removal of epidural catheter in this patient required a clinical decision, balancing the risk of epidural hematoma with continuation of antiplatelet therapy against the risk of coronary re-thrombosis with discontinuation of the medication. We followed a strategy that combined a short duration of discontinuation of therapy, assessment of platelet functions by laboratory test, transfusion of platelets and removal of catheter, followed by restart of anticoagulation, which proved safe for the patient.
authors: Department of Anesthesia and ICU, Sultan Qaboos University Hospital, Muscat. P.O. Box: 239, PC 115, Madinat Qaboos, Muscat, Oman. jyotiburad@yahoo.com
authors: Jyoti
authors: J
authors: Burad
authors: Rajini
authors: R
authors: Kausalya
authors: Mohammed
authors: M
authors: Ismaili
authors: Qutaiba
authors: Q
authors: Tawafic
authors: Rohit
authors: R
authors: Date
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D015360:Analgesia, Epidural / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*
chemical_list: D010975:Platelet Aggregation Inhibitors