title: Retrospective analysis of the incidence of epidural haematoma in patients with epidural catheters and abnormal coagulation parameters.
abstract: BACKGROUND
  Epidural haematoma is a rare but potentially catastrophic complication associated with epidural catheterization. The times of insertion and removal of epidural catheters are high-risk periods for epidural haematoma formation, especially with abnormal coagulation parameters. There is a lack of data on the incidence of epidural haematoma in patients with abnormal coagulation parameters.
  
  
  METHODS
  A retrospective analysis was undertaken from 2002 to 2009 on patients with an epidural catheter. Queries were performed on the coagulation parameters for the dates of placement and removal of the catheters and on all documented epidural haematoma cases.
  
  
  RESULTS
  During the study period, 11 600 epidural catheters were placed. In the setting of abnormal coagulation parameters, 278 (2.4%) epidural catheters were placed and 351 (3%) were removed. Two epidural haematomas occurred; both patients had epidural catheters and spinal drains placed for vascular procedures with abnormal coagulation parameters after operatation. The haematomas occurred after removal of the catheters. Based on our study, the incidence of epidural haematoma in patients with abnormal coagulation parameters is 1 in 315 patients, with the lower limit of the 95% confidence interval at 87 and the upper limit at 2597.
  
  
  CONCLUSIONS
  The risk of epidural haematoma is clearly elevated with abnormal coagulation parameters. Our data suggest that as the incidence of epidural haematoma with neuraxial access in patients with abnormal coagulation is not 100%, individual risk-benefit evaluations are warranted.
authors.affiliation: Massachusetts General Hospital, 15 Parkman Street, WACC 330, Boston, MA 02114, USA pgulur@yahoo.com.
authors.forename: P
authors.initials: P
authors.lastname: Gulur
authors.affiliation: Massachusetts General Hospital, 15 Parkman Street, WACC 330, Boston, MA 02114, USA.
authors.forename: B
authors.initials: B
authors.lastname: Tsui
authors.affiliation: Massachusetts General Hospital, 15 Parkman Street, WACC 330, Boston, MA 02114, USA.
authors.forename: R
authors.initials: R
authors.lastname: Pathak
authors.affiliation: Massachusetts General Hospital, 15 Parkman Street, WACC 330, Boston, MA 02114, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Koury
authors.affiliation: Massachusetts General Hospital, 15 Parkman Street, WACC 330, Boston, MA 02114, USA.
authors.forename: H
authors.initials: H
authors.lastname: Lee
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D001778:Blood Coagulation Disorders / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D012189:Retrospective Studies
keywords: anticoagulant; epidural analgesia; international normalized ratio; partial thromboplastin time; spinal epidural haematoma