Management of a Patient Requiring Intrathecal Drain Insertion and Removal in the Setting of Concomitant Dual Antiplatelet Therapy With Clopidogrel and Aspirin: A Case Report.
We report a case of deliberate intrathecal catheter insertion and removal in the setting of continuous dual-antiplatelet therapy with clopidogrel and aspirin. A patient with recently sited bare metal intracerebral stents developed severe symptomatic hydrocephalus and required temporary cerebrospinal fluid diversion. The risks of intracerebral in-stent thrombosis or delayed intervention precluded following guidelines for the management of clopidogrel in neuraxial procedures. Options to mitigate the risk of and facilitate the early detection of epidural hematoma are discussed when neuraxial instrumentation is indicated in the setting of clopidogrel and aspirin therapy.
From the Department of Anesthesiology and Pain Management, Maine Medical Center, Portland, Maine.
Christopher W
CW
Connors
Janie D
JD
Nguyen
D001241:Aspirin / Q000627:therapeutic use*; D002408:Catheters, Indwelling; D000077144:Clopidogrel; D020878:Device Removal; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004359:Drug Therapy, Combination; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D046748:Hematoma, Epidural, Spinal / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000628:therapy*; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D020767:Intracranial Thrombosis / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008670:Metals; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D008670:Metals; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin