Spinal epidural hematoma and high thromboembolic risk: Between scylla and charybdis

Objective: To determine the optimal time for reinstitution of anticoagulant therapy after evacuation of spinal epidural hematoma in patients who have a high risk for cardiogenic embolization. Material and Methods: The clinical histories of all patients with a spinal epidural hematoma encountered at Mayo Clinic Rochester between 1975 and 199 6 were reviewed. We present three cases of spontaneous spinal epidural hema toma and the management of anticoagulation in each case. Results: Of the 17 patients identified, 3 received anticoagulant therapy at the onset of the hematoma and were at high risk for cardiogenic embolizati on. In two patients with a metallic heart valve and one patient with long-s tanding atrial fibrillation, anticoagulant therapy was discontinued for 5, 13, and 18 days, respectively, after decompressive laminectomy, Systemic em bolization occurred in one patient with a previous history of embolization to the femoral artery. No systemic embolization occurred in the two patient s with a metallic valve, Conclusion: Early resumption of warfarin therapy is indicated after a spina l surgical procedure; however, discontinuation of anticoagulation for sever al days seems safe while postoperative hemostasis is monitored.