Spinal-epidural hematoma following epidural anesthesia in the presence of antiplatelet and heparin therapy.

ANTIPLATELET drugs are widely used in various categories of patients 1 ; therefore, knowledge of their impact on coagulation is important for the patients perioperative care. The American Society of Regional Anesthesia and Pain Medicine does not consider antiplatelet drugs, by themselves, as risk factors for the development of spinal hematoma in patients having neuraxial blocks, but concurrent use of other medications that affect clotting mechanisms may increase the risk of bleeding complications. 2,3 We report a case of an epidural hematoma in a patient to whom low-molecular-weight heparin (LMWH) was administered perioperatively as prophylaxis against development of venous thromboembolism and who additionally had taken oral ibuprofen for pain relief on her own.