title: [Risk consideration for peridural catheter removal in acute coronary syndrome. Epidural hematoma versus stent thrombosis].
abstract: Perioperative pain therapy using an epidural catheter is the standard operating procedure for numerous surgical interventions. The necessity of initiating anticoagulant therapy in a patient with an epidural catheter requires a careful weighing up between thromboembolic complications and epidural hematoma. The case presented here of a 47-year-old female patient who was operated on for mastectomy with a latissimus dorsi myocutaneous flap demonstrates a possible solution to this dilemma. The patient sustained a perioperative ST elevation myocardial infarction treated with drug-eluting stents while undergoing epidural pain therapy. By using the short-acting antiplatelet drug tirofiban over a time period of 7 days the gap for dual antiplatelet therapy was reduced with the help of specific platelet aggregation assays to a time frame of a few hours to minimize the risk of stent thrombosis. The epidural catheter was removed without complications under consideration of the current recommendations for regional anesthesia and antithrombotic agents.
authors: Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland, holgerboehle@gmx.de.
authors: H
authors: H
authors: Böhle
authors: J
authors: J
authors: Fröhlich
authors: R
authors: R
authors: Laufenberg-Feldmann
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation*; D057785:Catheters; D020878:Device Removal / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006406:Hematoma / Q000175:diagnosis*; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy*; D012306:Risk; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors