To the Editor.—
In his response to a question posed by Dr Russell, Dr Eichhorn1 makes the point that many anesthesiologists administer spinal or epidural anesthesia to patients receiving mini-dose heparin because there are no reported cases of epidural hematoma in such patients. However, Darnat et al2 report a case of a patient who was receiving 5000 U of calcium heparinate every 12 hours for antithrombotic therapy and had an epidural catheter placed through a 16-gauge Touhy needle for chronic pain relief. Blood was encountered with placement of the catheter, and an epidural hematoma with complete paraplegia developed over 3 hours, as diagnosed by contrast myelography. Surgery to improve the neurological deficit was unsuccessful.We agree with Dr Eichhorn's suggestion that checking a partial thromboplastin or activated clotting time prior to performance of a spinal or epidural puncture in patients receiving minidose heparin may be prudent. However, the
Parnass SM, Rothenberg DM, Fischer RL, Ivankovich AD. Spinal Anesthesia and Mini-Dose Heparin. JAMA. 1990;263(11):1496. doi:10.1001/jama.1990.03440110058025
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