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Anesth Analg 2004;99:595-597
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000130394.85483.C7

REGIONAL ANESTHESIA

Intraoperative Recombinant Activated Factor VII for Emergent Epidural Hematoma Evacuation

Tamas Szabo, MD PhD, Syed Ali, MD, and Enrico M. Camporesi, MD

Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, New York

Address correspondence and reprint requests to Tamas Szabo, MD, PhD, Department of Anesthesiology, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210. Address e-mail to tamas.szabo{at}excite.com

We report a case of a chronically anticoagulated 59-yr-old woman who underwent an L4 to L5 epidural block to relieve her low back pain and subsequently developed a T7 to L5 epidural hematoma with cauda equina and conus compression. Fresh frozen plasma and vitamin K were given before surgery, whereas recombinant activated factor VII was administered during surgery to reverse the coagulopathy and to enable the emergent laminectomy and hematoma evacuation. Recombinant activated factor VII administration proved to be a useful adjunct in the emergent surgical management of a thoracolumbar epidural hematoma.

IMPLICATIONS: We report a case of a chronically anticoagulated patient who developed an epidural hematoma after an epidural injection. Recombinant activated factor VII (rFVIIa) was administered during surgery to achieve hemostasis and to enable the hematoma evacuation. We also review additional cases in the literature in which rFVIIa was used.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.