Intrathecal pump extraction in a patient on obligatory therapeutic anticoagulation: A Case Report

Gabrielle H. Li, BA1,  Petar Yanev, MD1,  Swathi Rayasam, MD2, & Lynn Kohan, MD1

1Department of Anesthesia, University of Virginia, Charlottesville, Virginia

2Department of Anesthesia, UT Southwestern Medical Center, Dallas, Texas

Background:

●Surgical site infection with possible skin dehiscence is a potential risk following surgery, most commonly occurring within the first three months.1

●Current ASRA Pain Medicine guidelines advise holding dual antiplatelet therapy (DAPT) for seven days prior to high-risk neuraxial interventions including intrathecal catheter access or removal.2

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●However, for complex patients with documented implantable device infection requiring urgent system removal while on DAPT, there is a lack of recommendations addressing how to balance risk of infection against that of bleeding or re-thrombosis. 3