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Published on: June 18, 2021

Spontaneous spinal epidural hematoma: an urgent complication of adding clopidogrel to aspirin therapy

Hong-Joo Moon1, Joo Han Kim, Jong-Hyun Kim

  • 1Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

Journal of the Neurological Sciences
|July 29, 2009
PubMed

Insights

Dual antiplatelet therapy with aspirin and clopidogrel increased bleeding risk, leading to spontaneous spinal epidural hematoma (SSEH) in a patient with coronary artery disease. Prompt diagnosis and surgical evacuation resulted in an excellent outcome.

Area of Science:

  • Cardiology
  • Neurosurgery
  • Pharmacology

Background:

  • A 56-year-old male with a 19-year history of antihypertensive medication and prophylactic aspirin use presented with stable angina and coronary artery stenosis.
  • The patient underwent successful drug-eluting coronary stent placement, with clopidogrel added to his regimen.

Observation:

  • Post-procedure, the patient developed severe back pain, radiculopathy, and left leg weakness.
  • Magnetic Resonance Imaging (MRI) revealed a spontaneous spinal epidural hematoma (SSEH).

Findings:

  • The patient experienced an excellent outcome following emergent surgical evacuation of the SSEH.
  • This case highlights the potential for dual antiplatelet therapy (aspirin + clopidogrel) to increase bleeding complications, consistent with findings from the MATCH study.

Implications:

  • Physicians must be aware of the increased bleeding risk associated with dual antiplatelet therapy, particularly in patients with pre-existing conditions or those undergoing procedures.
  • Caution is advised when prescribing clopidogrel in addition to aspirin due to the potential for serious bleeding events like SSEH.
  • Timely diagnosis and intervention are crucial for managing SSEH and achieving favorable patient outcomes.

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