Spinal/Epidural Hematomas

• When neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture is employed, patients anticoagulated with or scheduled to be anticoagulated with selective inhibitors of thrombin such as desirudin may be at risk of developing an epidural or spinal hematoma which can result in long-term or permanent paralysis.
• The risk of these events is increased by the use of indwelling spinal catheters for administration of analgesia, repeated/traumatic epidural/spinal puncture, or the use of other drugs affecting hemostasis (e.g., NSAID, platelet inhibitors, other anticoagulants).
• Patients should be frequently monitored for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.
• Physicians should consider the potential benefit versus risk before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis. (See warnings)