Spontaneous epidural haematoma presenting as cord compression in a patient receiving clopidogrel
[Show abstract] [Hide abstract] ABSTRACT: We report a 56-year-old patient who had been taking antihypertensive medication in combination with prophylactic aspirin for 19 years who was diagnosed with stable angina with significant coronary artery stenosis on angiography. He was treated with drug-eluting coronary stent placement. Clopidogrel was added to the previous treatment regimen after stent placement. He visited the emergency room with complaints of severe back pain accompanied by radiculopathy and left leg weakness. The patient had an excellent outcome after immediate diagnosis by MRI and emergent evacuation of spontaneous spinal epidural hematoma (SSEH). The present case is interesting because it is the first case in spine which corresponds to the findings of MATCH study that bleeding tendency would be raised by dual antiplatelet treatment (aspirin+clopidogrel). With the popularity of antiplatelet medications, physicians should be aware of this critical side effect and provide urgent treatment. Furthermore, we should be cautious when we prescribe clopidogrel in addition to aspirin because it could cause bleeding complications like SSEH.
- "The specific T2-weighted signals were hyperintense with hypointense foci, resembling a mosaic pattern . Though controversial, some risk factors, including anticoagulant therapy , aspirin [16,, clopidogrel  , coronary throm- bolysis [12,16,22], hypertension [16,have been proposed. Because these factors frequently occur in the general population, they cannot be the only cause of SSEH, but they can play an important role in 2. Post-operative T2-weighted MRI images. "
[Show abstract] [Hide abstract] ABSTRACT: The hemorrhagic side effects associated with the use of clopidogrel are within the acceptable range and occur mainly at skin or gastrointestinal sites. We report a case of spontaneous spinal epidural hematoma (SSEH) in a 60-yr-old woman who was treated with clopidogrel for frequent transient ischemic attacks. To our knowledge, this is the second reported case of clopidogrel-induced SSEH. The patient's symptoms and past history of clopidogrel use suggested the diagnosis and made the procedure proceed quickly to operate SSEH 9 hr after the onset of paraplegia. The outcome was excellent. Therefore, with the popularity of antiplatelet prescription, physicians should keep in mind and urgently treat this unusual but critical side effect.
- "Antiplatelet agents are frequently used and their hemorrhagic complications occur usually at skin or gastrointestinal sites. Compared to anticoagulants, only four cases of aspirin- and one case of clopidogrel-induced SSEH have been reported (2-6). There is one case of spinal anesthesia-induced spinal epidural hematoma in a patient treated with clopidogrel and enoxaparin (12). "
- [Show abstract] [Hide abstract] ABSTRACT: Introduction: Clopidogrel is a potent oral antiplatelet agent that is commonly prescribed to patients with cardiovascular disease. Patients presenting with proximal femoral fractures often have cardiovascular comorbidity, with many taking clopidogrel on admission. Scientific literature reports increased surgical bleeding in patients receiving clopidogrel, though not specifically hip surgery. This study looked at whether patients who had a seven-day delay prior to operative treatment had less bleeding than those who did not, and looked at the differences in length of admission between the two groups. Methods: A retrospective review was undertaken. Patients were identified from the in-patient pharmacy stock records from July 2005 to July 2006. Data was statistically analyzed using the chi-squared test. Results: Of 21 patients identified, 20 met the inclusion criteria, nine had a seven-day delay before operation (Group A), and 11 had a mean one-day delay (Group B). Mean drop in postoperative hemoglobin was 1.8 g/l in Group A compared to 3.1 g/l in Group B (p < 0.05). Number of complications was similar (Group A = 8 vs. Group B = 9) as was mortality (Group A = 1 vs. Group B = 2). Admission length was longer in patients who had a seven-day delay in surgery (Group A = 32 vs. Group B = 22 days) (p < 0.05). Conclusion: Patients should be considered for early operation provided there are no additional bleeding risk factors, as although postoperative hemoglobin is lower, mortality and complication rates are similar, and length of admission is shorter.
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