Atypical presentation of an epidural hematoma in a patient receiving aspirin and low molecular weight heparin. Was epidural analgesia the right choice?

Kasodekar, Shilpa V.; Goldszmidt, Eric; Davies, Sharon R.

doi:10.1016/j.jclinane.2008.12.022

« Previous Next »Journal of Clinical Anesthesia
Volume 21, Issue 8 , Pages 595-598, December 2009

Atypical presentation of an epidural hematoma in a patient receiving aspirin and low molecular weight heparin. Was epidural analgesia the right choice?☆

Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada M5G 1X5

Received 14 May 2007; received in revised form 2 December 2008; accepted 4 December 2008. published online 23 October 2009.

Abstract

A case of postoperative epidural hematoma with an atypical presentation and an excellent outcome in an 80 year-old woman who received both prophylactic aspirin and enoxaparin following a primary total knee arthroplasty, is presented. She developed lower limb neurological symptoms, fully recovered, and then deteriorated again. The hematoma was surgically evacuated, resulting in full neurological recovery. Epidural analgesia may not be the best choice for pain management in patients who require the combined use of aspirin and low-molecular weight heparin postoperatively.

Keywords: Epidural analgesia, Epidural hematoma, Aspirin, Low-molecular weight heparin