Der Anaesthesist
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Case Reports
[Symptomatic epidural haematoma under therapeutic dose heparin: occurrence after removal of a peridural catheter].
A 55-year-old patient with severe arterial occlusive disease underwent a femoral artery bypass operation under combined spinal-epidural anaesthesia. Platelet count and coagulation tests were normal after phenprocoumon had been discontinued. The epidural catheter was removed on day 1 while the patient was under therapeutic dose heparin. ⋯ Computed tomography and magnetic resonance imaging showed a lumbar epidural haematoma, which together with a previously existing protrusion of the fourth lumbar disc, compressed the cauda equina. A neurosurgical consultation recommended a conservative approach. The symptoms resolved spontaneously and the patient was discharged in good condition 12 days after the operation.
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Case Reports
[Patient with heparin-induced thrombocytopenia type II and implanted left ventricular assist device].
The administration of heparin can lead to life-threatening heparin-induced thrombocytopenia (HIT) type II, which is caused by antibodies against heparin-platelet factor 4-complexes. The multimorbid patient presented here suffered from HIT II. ⋯ During therapy with argatroban, discrepancies in the partial thromboplastin time (PTT) and the international normalized ratio (INR) appeared sporadically. The clinical causes for these differences remain unclear.