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Epidural analgesia and abnormal coagulation in patients undergoing minimal invasive repair of pectus excavatum


1 Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
2 Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital; Department of Physiology, Aarhus University, Aarhus, Denmark
3 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
4 Department of Clinical Biochemistry, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
5 Department of Cardiothoracic Anesthesia, Aarhus University Hospital, Aarhus, Denmark
6 Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

Correspondence Address:
Ara S Media
Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N
Denmark
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_115_21

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Year : 2022  |  Volume : 25  |  Issue : 2  |  Page : 153-157

 

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Background: Epidural analgesia (EA) is effective in patients undergoing minimal invasive repair of pectus excavatum (MIRPE) but is associated with major complications such as epidural hematomas. It is recommended to assess coagulation status in patients receiving anticoagulant therapy prior to EA, although no consensus exists in patients without a history of bleeding tendency or anticoagulant therapy. Thus, the aim of this paper was to assess 1) the prevalence of abnormal routine coagulation parameters, i.e., international normalized ratio (INR) and platelet count, and 2) the safety of EA in patients undergoing MIRPE. Methods: In this retrospective study, we identified 1,973 patients undergoing MIRPE at our center between 2001 and 2019. Complications related to EA were registered for all patients. Information on coagulation parameters was present in 929 patients. Patients with spontaneously elevated INR ≥1.5 were referred for assessment of coagulation factor VII in order to assess the cause of the elevated INR. Results: Of 929 patients with coagulation information available, 18 patients had spontaneously elevated INR ≥1.5 (1.9%). In patients with INR ≥1.5, 12 patients underwent further assessment of factor VII, with all patients having a slightly reduced factor VII close to the lower reference range. The majority of the 1,973 patients undergoing MIRPE received EA (99.6%) with very low complication rates (0.2%) and no incidence of epidural hematomas. Conclusion: In patients undergoing MIRPE, coagulation screening prior to EA should not be mandatory as it revealed no clinically relevant consequences. EA is safe with very low complication rates.






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1 Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
2 Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital; Department of Physiology, Aarhus University, Aarhus, Denmark
3 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
4 Department of Clinical Biochemistry, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
5 Department of Cardiothoracic Anesthesia, Aarhus University Hospital, Aarhus, Denmark
6 Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

Correspondence Address:
Ara S Media
Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N
Denmark
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_115_21

Rights and Permissions

Background: Epidural analgesia (EA) is effective in patients undergoing minimal invasive repair of pectus excavatum (MIRPE) but is associated with major complications such as epidural hematomas. It is recommended to assess coagulation status in patients receiving anticoagulant therapy prior to EA, although no consensus exists in patients without a history of bleeding tendency or anticoagulant therapy. Thus, the aim of this paper was to assess 1) the prevalence of abnormal routine coagulation parameters, i.e., international normalized ratio (INR) and platelet count, and 2) the safety of EA in patients undergoing MIRPE. Methods: In this retrospective study, we identified 1,973 patients undergoing MIRPE at our center between 2001 and 2019. Complications related to EA were registered for all patients. Information on coagulation parameters was present in 929 patients. Patients with spontaneously elevated INR ≥1.5 were referred for assessment of coagulation factor VII in order to assess the cause of the elevated INR. Results: Of 929 patients with coagulation information available, 18 patients had spontaneously elevated INR ≥1.5 (1.9%). In patients with INR ≥1.5, 12 patients underwent further assessment of factor VII, with all patients having a slightly reduced factor VII close to the lower reference range. The majority of the 1,973 patients undergoing MIRPE received EA (99.6%) with very low complication rates (0.2%) and no incidence of epidural hematomas. Conclusion: In patients undergoing MIRPE, coagulation screening prior to EA should not be mandatory as it revealed no clinically relevant consequences. EA is safe with very low complication rates.






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