title: Spinal haematoma after removal of a thoracic epidural catheter in a patient with coagulopathy resulting from unexpected vitamin K deficiency.
abstract: Postoperative epidural analgesia is effective and widely utilised after major abdominal surgery. Spinal haematoma is a rare and devastating complication after epidural analgesia. Well-established risk factors for the development of spinal haematoma after neuraxial procedures have been documented. We present the case of a patient with normal pre-operative coagulation parameters who developed a spinal haematoma more than 24 h after removal of an epidural catheter; she had been without oral intake for only 4 days during which time she developed vitamin K-deficient coagulopathy. Clinicians should consider pre-operative screening of coagulation (International Normalised Ratio), or giving vitamin K supplementation, before performing neuraxial procedures in patients who are at risk of developing vitamin K deficiency or coagulopathy in the peri-operative period.
authors.affiliation: Department of Anesthesia, University of Toronto, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Ladha
authors.forename: A
authors.initials: A
authors.lastname: Alam
authors.forename: C
authors.initials: C
authors.lastname: Idestrup
authors.forename: J
authors.initials: J
authors.lastname: Sawyer
authors.forename: S
authors.initials: S
authors.lastname: Choi
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000768:Anesthesia, General; D000925:Anticoagulants / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000517:prevention & control; D001779:Blood Coagulation Factors / Q000032:analysis; D002404:Catheterization / Q000009:adverse effects*; D017984:Enoxaparin / Q000627:therapeutic use; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery; D046649:Hematoma, Subdural, Spinal / Q000209:etiology*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D013927:Thrombosis / Q000517:prevention & control; D014813:Vitamin K Deficiency / Q000150:complications*; D006475:Vitamin K Deficiency Bleeding / Q000150:complications*
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D017984:Enoxaparin