[Removal of an epidural catheter under ongoing antithrombotic therapy]

A rare though extremely harmful complication in neuraxial anaesthesia is an epidural hematoma which can be associated with deleterious consequences for the patient, e. g. persistent paraplegia. The risk of epidural haematomas after neuraxial blockade is dependent on abnormal anatomy of the spine, difficult and multiple punctures and coagulation disorders. Especially when patients undergo therapy with anticoagulants like low molecular heparin or platelet inhibitors (tyclopidine) or a combination of them, the indication for neuraxial blockade must strictly outweigh risk of spinal bleeding. In this context, the precautions and contraindications are the same for spinal puncture and catheter insertion as for catheter removal. We describe the case of a patient who underwent emergency coronary angioplasty in combination with coronary stent implantation due to acute postoperative myocardial infarction following knee replacement in continuous epidural anaesthesia. Under the symptoms of a beginning local infection at the puncture site the epidural catheter had to be removed in spite of ongoing antithrombotic therapy. A possible management of such cases is discussed with regard to risk minimization.