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Epidural blood patch in a patient taking enoxaparin
Robert R Gaiser1, Darryl H Berkowitz, Doris Chou
1Department of Anesthesia, University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
Journal of Clinical Anesthesia
|September 18, 2004
Summary
A postdural puncture headache in a pregnant patient on enoxaparin was successfully treated with an epidural blood patch. Careful management of enoxaparin dosing allowed for safe and effective headache relief.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Hematology
Background:
- Postdural puncture headache (PDPH) is a potential complication of neuraxial procedures in obstetrics.
- Factor V Leiden mutation increases thrombotic risk, often necessitating anticoagulation with enoxaparin during pregnancy.
- Managing anticoagulation in parturient patients undergoing procedures requiring epidural blood patch presents unique challenges.
Observation:
- A 36-year-old, 204-kg parturient with Factor V Leiden on enoxaparin developed a PDPH.
- Neuraxial anesthesia and subsequent PDPH management required careful consideration of enoxaparin's pharmacokinetic profile.
Findings:
- Successful epidural blood patch was achieved through meticulous coordination of enoxaparin dosing.
- The procedure necessitated withholding enoxaparin for a specific duration prior to the blood patch.
Implications:
- This case highlights the feasibility of performing epidural blood patches in pregnant patients receiving enoxaparin.
- Effective management strategies can mitigate risks associated with anticoagulation and PDPH treatment.
- Optimized patient care pathways are crucial for managing complex obstetric cases involving thrombophilia and neuraxial procedures.