Anticoagulation Management During a Spinal Cord Stimulator Trial on a Patient With ST-Elevation Myocardial Infarction

Area of Science:

• Pain Management
• Cardiology
• Neurosurgery

Background:

• Spinal cord stimulators (SCS) are used for chronic pain, often involving a trial period before permanent implantation.
• Patients on anticoagulation require adherence to specific guidelines during SCS procedures.
• Managing anticoagulation in patients undergoing SCS trials presents unique challenges.

Observation:

• A patient with a recent ST-elevation myocardial infarction (STEMI) underwent an SCS trial.
• Dual antiplatelet therapy (DAPT) was initiated post-coronary revascularization, increasing epidural hematoma risk.
• The SCS trial was continued despite the high bleeding risk associated with DAPT.

Findings:

• The patient required bridging with intravenous antiplatelet agents before SCS trial removal.
• Close monitoring was essential to manage the anticoagulation and SCS trial interplay.
• This case underscores the complexity of managing SCS in patients with acute cardiac events.

Implications:

• Development of specialized anticoagulation protocols for SCS patients with recent STEMI is crucial.
• Individualized risk assessment is necessary to balance thrombosis prevention and bleeding complications.
• Further research into optimal anticoagulation strategies for SCS in high-risk cardiac patients is warranted.