Case report Corresponding author: Ageliki Pandazi 2nd Department of Anaesthesiology University of Athens School of Medicine, Attikon Hospital 1 Rimini St, Chaidari Athens, Greece Phone: +30 210 5832371 Fax: +30 210 5326413 E-mail: angpant@med.uoa.gr Epidural haematoma after epidural catheter removal under multiple anticoagulant therapy: report of two cases Ageliki Pandazi1, Periandros Karamanis1, Paraskevi Matsota1, Stella Kontogiannopoulou1, Kostantinos Soultanis2, Georgia Kostopanagiotou1 12nd Department of Anaesthesiology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece 21st Department of Orthopaedics, University of Athens School of Medicine, Attikon Hospital, Athens, Greece Submitted: 23 September 2009 Accepted: 7 October 2009 Arch Med Sci 2010; 6, 2: 281-282 DOI: 10.5114/aoms.2010.13910 Copyright © 2010 Termedia & Banach A b s t r a c t We report two cases of epidural haematoma that probably developed after removal of the epidural catheter in patients receiving multiple anticoagulant and antiplatelet therapy. The first case is a 77-year-old male patient who underwent femoropopliteal artery bypass grafting surgery. The second case is a 77-year-old woman who underwent a semi-total replacement of the right hip, three days after she had a subtrochanteric fracture. Emergency laminectomy was performed in both patients but none experienced a full recovery. Key words: epidural haematoma, antiplatelets, anticoagulants. Case report The first case is a 77-year-old male patient who underwent femoro- popliteal artery bypass grafting surgery. He had a medical history of hypertension, coronary artery disease and type II diabetes mellitus. His medications included nebivolol, amlodipine, furosemide, isosorbide mononitrate and clopidogrel (that was discontinued 7 days before operation and substituted by enoxaparin sodium 4,000 IU subcutaneously [SC] twice daily). The second case is a 77-year-old woman who underwent a semi- total replacement of the right hip, three days after she had a subtrochanteric fracture. She had a medical history of coronary artery disease and left heart failure, atrial fibrillation and type II diabetes mellitus. Her medication included furosemide and short acting insulin. During her hospitalization she was given enoxaparin 6,000 IU SC once daily. The last dose of enoxaparin sodium was injected 24 and 12 h respectively before scheduled operations. Coagulation tests and thrombocyte count before both operations were within normal values. A single pass, atraumatic epidural (ED) was performed at the L3–L4 interspace with an 18-gauge Tuohy epidural needle and an epidural catheter was placed in both cases and remained for postoperative analgesia. Both patients recovered sensation and full motor power in the lower limbs after the end of the operation. Removal of the ED catheter was decided, in the first case, on the 1st postoperative day. Coagulation tests and thrombocyte count were checked and found within normal values. The patient had normal sensation and strength of the lower limbs at the time of catheter removal. Two hours after catheter removal