Correspondence  |   May 2003
Central Block or Not Central Block under Ticlopidine Therapy?: In Reply:—
Author Affiliations & Notes
  • Christoph Maier, M.D., Ph.D.
  • *Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum, Germany.
Article Information
Correspondence   |   May 2003
Central Block or Not Central Block under Ticlopidine Therapy?: In Reply:—
Anesthesiology 5 2003, Vol.98, 1301. doi:
Anesthesiology 5 2003, Vol.98, 1301. doi:
In Reply:—
We thank Dr. Fattorutto for his comments and for providing two additional references to our topic. 1,2 One of these case reports has already been included in the review of Urmey and Rowlingson. 3 However, these case reports and this review did not influence European and US guidelines at all. Dr. Fattorutto cites the study of Horlocker et al.  , 4 which is no counterargument because the patients received aspirin-like drugs, but none of them received an irreversible antiplatelet aggregation inhibitor like ticlopidine. The authors were aware of the small power of their retrospective trial, which lead them to the conclusion that “the finding of zero events does not imply the risk is zero in the whole population.”4 Life-threatening bleeding is not a statistical problem; any bleeding is too much bleeding. Therefore, we appreciate Dr. Fattoruto's comments. To prevent bleeding, our recommendation should not be neglected. 5 Any medication with irreversible antiplatelet aggregation inhibitors should be discontinued for at least 7 days before any invasive techniques like neuroaxial blockade, in which hemorrhage cannot be controlled by external compression.
Mayumi T, Dohi S: Spinal subarachnoid hematoma after lumbar puncture in a patient receiving antiplatelet therapy. Anesth Analg 1983; 62: 777–9Mayumi, T Dohi, S
Kawaguchi S, Tokutomi S: A case of epidural hematoma associated with epidural catheterization which occurred on 12th day after the last medication of ticlopidine hydrochloride. Masui 2002; 51: 526–8Kawaguchi, S Tokutomi, S
Urmey WF, Rowlingson JC: Do antiplatelet agents contribute to the development of perioperative spinal hematoma? Reg Anesth Pain Med 1998; 23 (suppl 2): 146–51Urmey, WF Rowlingson, JC
Horlocker T, Wedel DJ, Schroeder DR, Rose SH, Elliot BA, Mc Gregor DG, Wong GY: Preoperative antiplatelet therapy does not increase the risk of spinal hematoma associated with regional anesthesia. Anesth Analg 1995; 80: 303–9Horlocker, T Wedel, DJ Schroeder, DR Rose, SH Elliot, BA Mc Gregor, DG Wong, GY
Maier C, Gleim M, Weiss T, Stachetzki U, Nicolas V, Zenz M: Severe bleeding following lumbar sympathetic blockade in two patients under medication with irreversible platelet aggregation inhibitors. A nesthesiology 2002; 97: 740–3Maier, C Gleim, M Weiss, T Stachetzki, U Nicolas, V Zenz, M