[Risk consideration for peridural catheter removal in acute coronary syndrome : Epidural hematoma versus stent thrombosis.]

[Risk consideration for peridural catheter removal in acute coronary syndrome : Epidural hematoma versus stent thrombosis.]
Anaesthesist. 2014 Jul 25;
Authors: Böhle H, Fröhlich J, Laufenberg-Feldmann R
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.
PMID: 25056411 [PubMed - as supplied by publisher]

Source: Der Anaesthesist - July 25, 2014 Category: Anesthesiology Authors: Böhle H, Fröhlich J, Laufenberg-Feldmann R Tags: Anaesthesist Source Type: research