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Removal of an Epidural Catheter in a Patient Receiving Ticagrelor: A Case Report

Harshal D Wagh1, Prashant K Nair2, Deepak B Bhushan1

  • 1From the Department of Anesthesiology, Kokilaben Ambani Hospital, Mumbai, India.

A&A Practice
|June 19, 2023
PubMed

Insights

Managing antiplatelet therapy during epidural catheter removal after knee surgery requires careful planning. This case highlights the importance of multidisciplinary collaboration and neurologic monitoring to prevent spinal hematoma.

Area of Science:

  • Anesthesiology
  • Cardiology
  • Orthopedic Surgery

Background:

  • A patient underwent bilateral total knee arthroplasties under combined spinal epidural anesthesia.
  • The patient also had a history of coronary angioplasty and was on dual antiplatelet therapy (heparin, clopidogrel, and ticagrelor).

Observation:

  • The epidural catheter was removed 5 days after the last dose of clopidogrel, following a multidisciplinary team decision.
  • Ticagrelor was continued while the epidural catheter was still in place to mitigate the risk of stent thrombosis.

Findings:

  • The management of epidural catheter removal in patients on antiplatelet therapy necessitates a thorough risk-benefit analysis.
  • Close collaboration among anesthesiology, cardiology, and orthopedic surgery teams is crucial.

Implications:

  • Stringent neurologic monitoring is essential post-removal to detect any signs of spinal hematoma promptly.
  • Optimizing neurologic outcomes depends on the rapid diagnosis and treatment of potential complications.
  • This case underscores the need for individualized patient management protocols in complex perioperative scenarios.

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