Department of Orthopaedic Surgery, Stanford University, Palo Alto, CA 94063-6342, USA.
Spine J. 2011 Jan;11(1):e1-4. doi: 10.1016/j.spinee.2010.10.013. Epub 2010 Nov 20.
The use of antiplatelet agents after coronary artery stent placement is currently recommended to prevent coronary stent obstruction. These patients may have concurrent disabling spinal stenosis and require spinal decompression. Resuming antiplatelet agents as soon as possible after spinal surgery is recommended.
To describe a unique case of late postoperative epidural hematoma occurring with the use of clopidogrel.
A case report and review of the literature.
The hospital chart, history, physical examination, and imaging of a single patient were reviewed.
A 59-year-old man underwent spinal decompression and fusion for neurogenic claudication with lumbar spinal stenosis and spondylolisthesis while managed on clopidogrel for prevention of thrombosis after cardiac stent placement. He developed a symptomatic epidural hematoma 12 days postoperatively, well outside the usual time frame for this complication. The patient was closely monitored, and lumbar radiculopathy resolved over the ensuing days.
After spinal surgery and resumption of antiplatelet therapy, the physician needs to maintain vigilance in observing patients for late postoperative complications such as epidural hematoma, which could have catastrophic consequences if not recognized in a timely manner.
目前建议在冠状动脉支架置入术后使用抗血小板药物，以预防冠状动脉支架阻塞。这些患者可能同时患有致残性脊柱狭窄，并需要进行脊柱减压。建议在脊柱手术后尽快恢复使用抗血小板药物。
描述一例使用氯吡格雷时发生的罕见术后晚期硬膜外血肿的病例。
病例报告和文献复习。
回顾了一名患者的住院病历、病史、体格检查和影像学资料。
一名 59 岁男性因心脏支架置入术后预防血栓而服用氯吡格雷，同时患有神经源性跛行、腰椎管狭窄症和腰椎滑脱，行脊柱减压融合术。术后 12 天出现症状性硬膜外血肿，明显超出该并发症的常见时间范围。患者得到密切监测，腰神经根病在随后的几天内得到缓解。
脊柱手术后恢复抗血小板治疗后，医生需要保持警惕，观察患者是否出现硬膜外血肿等晚期术后并发症，如果不能及时发现，可能会产生灾难性后果。
