title: A patient who received clopidogrel with an indwelling epidural catheter.
abstract: A patient with a drug-eluting stent placed 18 months earlier received a thoracic epidural for perioperative analgesic control as part of her thoracotomy. Postoperatively, the patient was started on clopidogrel for secondary prevention. After consultation with the Hematology service and a platelet function assay, the patient was transfused two pools of platelets and the epidural catheter was removed on postoperative day 4. The patient then underwent hourly neurologic checks for 24 hours and was discharged several days later without any negative sequelae. If neuraxial techniques and the need for clopidogrel prophylaxis come into direct conflict, vigilance is necessary for warning signs of epidural hematoma and platelet transfusion should be considered to reverse the effects of the drug.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10128, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Hamburger
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA. Electronic address: ihofer@mednet.ucla.edu.
authors.forename: Ira S
authors.initials: IS
authors.lastname: Hofer
authors.affiliation: Department of Anesthesiology/Division of Pain Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10128, USA.
authors.forename: Yury
authors.initials: Y
authors.lastname: Khelemsky
mesh_terms: D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D002408:Catheters, Indwelling; D000077144:Clopidogrel; D020878:Device Removal / Q000379:methods; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D010149:Postoperative Pain / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D017713:Platelet Transfusion; D011182:Postoperative Care / Q000379:methods; D013908:Thoracotomy; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Clopidogrel; Drug-eluting stent; Thoracotomy