Time Is Bleeding Risk: A Case Report of Epidural Catheter Management in Two Patients Receiving Emergent Antithrombotic Therapy

American Society of Regional Anesthesia and Pain Medicine guidelines recommend holding most antiplatelet therapy before inserting an epidural catheter; however, guidance for patients acutely initiated on antiplatelet therapy with a catheter in situ is limited. Here, we describe the management of 2 cases of patients with indwelling epidural catheters for pain management who developed acute myocardial infarctions necessitating emergent antiplatelet therapy. Established pharmacokinetics demonstrate maximal platelet inhibition occurs within 30 minutes in ticagrelor and 4 to 6 hours in clopidogrel, suggesting early removal results in decreased the risk of epidural hematoma.