Oral anticoagulant prophylaxis and epidural catheter removal

Christopher L. Wu, Frederick M. Perkins

Research output: Contribution to journalArticle

Abstract

Background and Objectives. The use of regional anesthesia in patients receiving anticoagulants is controversial. The purpose of this review is to document the incidence of neurologic complications with insertion and removal of an epidural catheter in patients receiving oral anticoagulants and antiplatelet medication. Methods. A retrospective review was made of the charts of 459 patients who underwent hip pinning or hip or knee replacement under regional anesthesia and received postoperative epidural analgesia and warfarin thromboembolism prophylaxis. The number of patients receiving preoperative antiplatelet therapy and warfarin, as well as baseline coagulation parameters, was documented. For patients who had postoperative epidural analgesia, the prothrombin time on the day of epidural catheter removal was obtained. Neurologic complications during the hospital stay were noted. Results. Spinal anesthesia was administered to 47 patients and epidural anesthesia and postoperative analgesia to 412. Before surgery, antiplatelet therapy was given to 270 and warfarin to 180 patients, with some patients receiving both. The mean ± SD preoperative prothrombin and partial thromboplastin times were 10.8 ± 1.2 seconds (normal, 9.6-11.1 seconds) and 27.5 ± 3.5 seconds (normal, 24.6-33.2 seconds), respectively. Blood on needle or catheter insertion was noted in 21 patients, all of whom were taking antiplatelet medication and/or warfarin. Epidural catheters remained postoperatively for a mean of 43.6 ± 12.5 hours (range 5-118 hours). The mean prothrombin time on the day of epidural catheter removal was 14.1 ± 3.2 seconds. Four postoperative peripheral neuropathies were detected. There was no clinical evidence of spinal hematoma in any patient. Conclusions. Epidural catheter placement and removal in patients taking oral anticoagulants appears to be safe. Careful monitoring of the patient for evidence of spinal hematoma after epidural catheter removal is recommended.

Original languageEnglish (US)
Pages (from-to)517-524
Number of pages8
JournalRegional Anesthesia
Volume21
Issue number6
StatePublished - 1996
Externally publishedYes

Fingerprint

Anticoagulants
Catheters
Warfarin
Epidural Analgesia
Conduction Anesthesia
Prothrombin Time
Nervous System
Hip
Spinal Epidural Hematoma
Anesthesia and Analgesia
Partial Thromboplastin Time
Epidural Anesthesia
Spinal Anesthesia
Thromboembolism
Physiologic Monitoring
Prothrombin
Peripheral Nervous System Diseases
Hematoma
Needles
Length of Stay

Keywords

  • antiplatelet medication
  • catheter removal
  • epidural anesthesia spinal anesthesia
  • hematoma
  • warfarin

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Wu, C. L., & Perkins, F. M. (1996). Oral anticoagulant prophylaxis and epidural catheter removal. Regional Anesthesia, 21(6), 517-524.

Oral anticoagulant prophylaxis and epidural catheter removal. / Wu, Christopher L.; Perkins, Frederick M.

In: Regional Anesthesia, Vol. 21, No. 6, 1996, p. 517-524.

Research output: Contribution to journalArticle

Wu, CL & Perkins, FM 1996, 'Oral anticoagulant prophylaxis and epidural catheter removal', Regional Anesthesia, vol. 21, no. 6, pp. 517-524.
Wu, Christopher L. ; Perkins, Frederick M. / Oral anticoagulant prophylaxis and epidural catheter removal. In: Regional Anesthesia. 1996 ; Vol. 21, No. 6. pp. 517-524.
@article{f77b58efb70d4706b7690be596e8d5de,
title = "Oral anticoagulant prophylaxis and epidural catheter removal",
abstract = "Background and Objectives. The use of regional anesthesia in patients receiving anticoagulants is controversial. The purpose of this review is to document the incidence of neurologic complications with insertion and removal of an epidural catheter in patients receiving oral anticoagulants and antiplatelet medication. Methods. A retrospective review was made of the charts of 459 patients who underwent hip pinning or hip or knee replacement under regional anesthesia and received postoperative epidural analgesia and warfarin thromboembolism prophylaxis. The number of patients receiving preoperative antiplatelet therapy and warfarin, as well as baseline coagulation parameters, was documented. For patients who had postoperative epidural analgesia, the prothrombin time on the day of epidural catheter removal was obtained. Neurologic complications during the hospital stay were noted. Results. Spinal anesthesia was administered to 47 patients and epidural anesthesia and postoperative analgesia to 412. Before surgery, antiplatelet therapy was given to 270 and warfarin to 180 patients, with some patients receiving both. The mean ± SD preoperative prothrombin and partial thromboplastin times were 10.8 ± 1.2 seconds (normal, 9.6-11.1 seconds) and 27.5 ± 3.5 seconds (normal, 24.6-33.2 seconds), respectively. Blood on needle or catheter insertion was noted in 21 patients, all of whom were taking antiplatelet medication and/or warfarin. Epidural catheters remained postoperatively for a mean of 43.6 ± 12.5 hours (range 5-118 hours). The mean prothrombin time on the day of epidural catheter removal was 14.1 ± 3.2 seconds. Four postoperative peripheral neuropathies were detected. There was no clinical evidence of spinal hematoma in any patient. Conclusions. Epidural catheter placement and removal in patients taking oral anticoagulants appears to be safe. Careful monitoring of the patient for evidence of spinal hematoma after epidural catheter removal is recommended.",
keywords = "antiplatelet medication, catheter removal, epidural anesthesia spinal anesthesia, hematoma, warfarin",
author = "Wu, {Christopher L.} and Perkins, {Frederick M.}",
year = "1996",
language = "English (US)",
volume = "21",
pages = "517--524",
journal = "Regional Anesthesia and Pain Medicine",
issn = "1098-7339",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Oral anticoagulant prophylaxis and epidural catheter removal

AU - Wu, Christopher L.

AU - Perkins, Frederick M.

PY - 1996

Y1 - 1996

N2 - Background and Objectives. The use of regional anesthesia in patients receiving anticoagulants is controversial. The purpose of this review is to document the incidence of neurologic complications with insertion and removal of an epidural catheter in patients receiving oral anticoagulants and antiplatelet medication. Methods. A retrospective review was made of the charts of 459 patients who underwent hip pinning or hip or knee replacement under regional anesthesia and received postoperative epidural analgesia and warfarin thromboembolism prophylaxis. The number of patients receiving preoperative antiplatelet therapy and warfarin, as well as baseline coagulation parameters, was documented. For patients who had postoperative epidural analgesia, the prothrombin time on the day of epidural catheter removal was obtained. Neurologic complications during the hospital stay were noted. Results. Spinal anesthesia was administered to 47 patients and epidural anesthesia and postoperative analgesia to 412. Before surgery, antiplatelet therapy was given to 270 and warfarin to 180 patients, with some patients receiving both. The mean ± SD preoperative prothrombin and partial thromboplastin times were 10.8 ± 1.2 seconds (normal, 9.6-11.1 seconds) and 27.5 ± 3.5 seconds (normal, 24.6-33.2 seconds), respectively. Blood on needle or catheter insertion was noted in 21 patients, all of whom were taking antiplatelet medication and/or warfarin. Epidural catheters remained postoperatively for a mean of 43.6 ± 12.5 hours (range 5-118 hours). The mean prothrombin time on the day of epidural catheter removal was 14.1 ± 3.2 seconds. Four postoperative peripheral neuropathies were detected. There was no clinical evidence of spinal hematoma in any patient. Conclusions. Epidural catheter placement and removal in patients taking oral anticoagulants appears to be safe. Careful monitoring of the patient for evidence of spinal hematoma after epidural catheter removal is recommended.

AB - Background and Objectives. The use of regional anesthesia in patients receiving anticoagulants is controversial. The purpose of this review is to document the incidence of neurologic complications with insertion and removal of an epidural catheter in patients receiving oral anticoagulants and antiplatelet medication. Methods. A retrospective review was made of the charts of 459 patients who underwent hip pinning or hip or knee replacement under regional anesthesia and received postoperative epidural analgesia and warfarin thromboembolism prophylaxis. The number of patients receiving preoperative antiplatelet therapy and warfarin, as well as baseline coagulation parameters, was documented. For patients who had postoperative epidural analgesia, the prothrombin time on the day of epidural catheter removal was obtained. Neurologic complications during the hospital stay were noted. Results. Spinal anesthesia was administered to 47 patients and epidural anesthesia and postoperative analgesia to 412. Before surgery, antiplatelet therapy was given to 270 and warfarin to 180 patients, with some patients receiving both. The mean ± SD preoperative prothrombin and partial thromboplastin times were 10.8 ± 1.2 seconds (normal, 9.6-11.1 seconds) and 27.5 ± 3.5 seconds (normal, 24.6-33.2 seconds), respectively. Blood on needle or catheter insertion was noted in 21 patients, all of whom were taking antiplatelet medication and/or warfarin. Epidural catheters remained postoperatively for a mean of 43.6 ± 12.5 hours (range 5-118 hours). The mean prothrombin time on the day of epidural catheter removal was 14.1 ± 3.2 seconds. Four postoperative peripheral neuropathies were detected. There was no clinical evidence of spinal hematoma in any patient. Conclusions. Epidural catheter placement and removal in patients taking oral anticoagulants appears to be safe. Careful monitoring of the patient for evidence of spinal hematoma after epidural catheter removal is recommended.

KW - antiplatelet medication

KW - catheter removal

KW - epidural anesthesia spinal anesthesia

KW - hematoma

KW - warfarin

UR - http://www.scopus.com/inward/record.url?scp=0029822855&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029822855&partnerID=8YFLogxK

M3 - Article

C2 - 8956387

AN - SCOPUS:0029822855

VL - 21

SP - 517

EP - 524

JO - Regional Anesthesia and Pain Medicine

JF - Regional Anesthesia and Pain Medicine

SN - 1098-7339

IS - 6

ER -