• H Böhle, J Fröhlich, and R Laufenberg-Feldmann.
• Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland, holgerboehle@gmx.de.
• Anaesthesist. 2014 Sep 1; 63 (8-9): 651-5.

AbstractPerioperative 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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