Spontaneous Spinal Epidural Hematoma After Combined Urokinase and Heparin Thrombolytic Therapy for Deep Venous Thrombosis

Abstract

The literature clearly supports the view that all anticoagulation therapy is associated with a significant risk of hemorrhagic complications. Combining anticoagulation and fibrinolytic therapy further adds to this risk. Moreover, in the treatment of deep venous thrombosis the combined use of heparin and fibrinolytic therapy is not necessarily associated with a better outcome. Close monitoring of the clotting profile has not eliminated the risks since a correlation between laboratory parameters and bleeding complications has not been demonstrated. Furthermore, the appropriate total dose and duration of therapy remain unclear. The authors report an especially devastating complication of spinal epidural hematoma with resultant paraplegia after combined use of heparin and urokinase for iliofemoral venous thrombosis in an otherwise healthy young woman. The dramatic nature of the complications illustrates the need for continued analysis of this therapeutic strategy.