Patients Erroneously administered Clopidogrel with an Epidural Catheter in situ: Case Series

Abstract

Background: It is recommended that anticoagulation therapy with agents, such as clopidogrel (Plavix ® ) be discontinued 7 days prior to neuraxial blockade with an epidural catheter due to an increased risk of epidural haematoma. However, patients are occasionally erroneously restarted on clopidogrel prior to catheter removal. Little research exists regarding the prevalence of this clinical scenario or the clinical outcomes. This may be particularly important for clopidogrel, since, unlike other anticoagulants, there are no pharmacological reversal agents. Objective: To examine the prevalence, management strategies and outcomes of patients given clopidogrel prior to epidural catheter removal at a medium-sized tertiary care teaching hospital. Materials and methods: Following institutional Research Ethics Board approval, electronic medical records of all patients who received epidural analgesia over a 1 year period were retrospectively reviewed. The charts for those patients who were also given clopidogrel prior to catheter removal were examined to determine the management course and treatment outcomes. Results: Of the 3959 patients who received epidural anaesthesia, three were given clopidogrel prior to catheter removal. No haematoma-related complications were reported. Patient management and treatment outcomes are described. Conclusion: Although this error appears to be a rare occurrence at our center and no adverse events were reported, it has the potential for serious adverse outcomes. Clinicians at our center manage this scenario by increasing the time to catheter removal, withholding heparin, administering platelets, monitoring and educating patients with respect to potential complications. Given that no adverse events were observed, such management strategies may be effective and prudent.