Zusammenfassung
Die perioperative Schmerztherapie mithilfe eines Periduralkatheters (PDK) stellt für viele Eingriffe ein Standardverfahren dar. Tritt unter liegendem PDK ein Zustand ein, der eine Antikoagulationstherapie erfordert, ist das Risiko einer epiduralen Blutung gegen das eines thrombembolischen Ereignisses abzuwägen. Im vorgestellten Fall eines perioperativen ST-Hebungsinfarkts, der mithilfe von „drug eluting stents“ (DES) therapiert wurde, konnten durch „bridging“ mit Tirofiban über 7 Tage planbare Bedingungen zur Entfernung des PDK geschaffen werden. Somit wurden beide Risiken „epidurales Hämatom“ vs. „Stent-Thrombose“ minimiert.
Abstract
Perioperative pain therapy using an epidural catheter is the standard operating procedure for numerous surgical interventions. The necessity of initiating anticoagulant therapy in a patient with an epidural catheter requires a careful weighing up between thromboembolic complications and epidural hematoma. The case presented here of a 47-year-old female patient who was operated on for mastectomy with a latissimus dorsi myocutaneous flap demonstrates a possible solution to this dilemma. The patient sustained a perioperative ST elevation myocardial infarction treated with drug-eluting stents while undergoing epidural pain therapy. By using the short-acting antiplatelet drug tirofiban over a time period of 7 days the gap for dual antiplatelet therapy was reduced with the help of specific platelet aggregation assays to a time frame of a few hours to minimize the risk of stent thrombosis. The epidural catheter was removed without complications under consideration of the current recommendations for regional anesthesia and antithrombotic agents.
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Interessenkonflikt. H. Böhle, J. Fröhlich, R. Laufenberg-Feldmann geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.
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Böhle, H., Fröhlich, J. & Laufenberg-Feldmann, R. Risikoabwägung vor Periduralkatheterentfernung bei akutem Koronarsyndrom. Anaesthesist 63, 651–655 (2014). https://doi.org/10.1007/s00101-014-2358-z
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DOI: https://doi.org/10.1007/s00101-014-2358-z