Acute spontaneous spinal epidural hematoma: an important differential diagnosis in patients under clopidogrel therapy

Background contextSpontaneous spinal epidural hematoma (SSEH) is an infrequent spinal pathology. Although it is related to numerous risk factors, its etiology remains unclear.PurposeThe aim of this article was to review the most important data in the literature about SSEH and to propose clopidogrel (Plavix®) therapy as a risk factor.Study designCase report.MethodsA 79-year-old woman was hospitalized in our unit with posterior thoracic pain and urinary retention of 72 hours duration. A clinical history was taken, and laboratory and imaging tests were performed. Urgent surgical decompression was performed, showing an epidural hematoma. Postoperative bacteriological cultures were negative, and microscopic analysis confirmed the diagnosis.ResultsFor this patient, clopidogrel (Plavix®) therapy was the only risk factor related to SSEH.ConclusionsIn any patient under clopidogrel (Plavix®: Sanofi-Synthelabo, Bristol-Myers Squibb/Sanofi Pharmaceuticals) therapy and with a typical clinical presentation, SSEH should be suspected and quickly diagnosed, regardless of hemostatic status or the absence of other major risk factors.