Spontaneous epidural haematoma presenting as cord compression in a patient receiving clopidogrel
Available from: Jae Taek Hong
- "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). "
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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.
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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.
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.
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
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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