title: Intravenous Tissue Plasminogen Activator Administration for Ischemic Stroke 1 Hour After Epidural Catheter Removal: A Case Report.
abstract: Anticoagulation after a recent neuraxial procedure poses risk for development of spinal hematoma. Clinical evidence supports prompt IV tissue plasminogen activator administration after onset of ischemic stroke. There is an absence of data regarding emergency fibrinolytic therapy for patients experiencing a stroke with recent neuraxial procedures, resulting in highly disparate, nonevidence-based guidelines. This report describes a patient who developed ischemic stroke when receiving postoperative epidural analgesia. Tissue plasminogen activator was emergently administered 1 hour after epidural catheter removal with a favorable recovery. The patient and his family reviewed the manuscript, and written consent to publish this case report was obtained from the patient.
authors.affiliation: From the *VA Puget Sound Health Care System, Department of Pharmacy, University of Washington, Seattle, Washington; †Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; ‡VA Puget Sound Health Care System, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; and §VA Puget Sound Health Care System, Department of Neurology, University of Washington, Seattle, Washington.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Baciewicz
authors.forename: Calvin
authors.initials: C
authors.lastname: Lee
authors.forename: Alon
authors.initials: A
authors.lastname: Ben-Ari
authors.forename: Hojoong
authors.initials: H
authors.lastname: Kim
authors.forename: Alex T
authors.initials: AT
authors.lastname: Lee
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D001005:Anus Neoplasms / Q000601:surgery*; D002408:Catheters, Indwelling; D020878:Device Removal; D013505:Digestive System Surgical Procedures; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000601:surgery*; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy*; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator