Spinal Epidural Hematoma Due to Heparin

To the Editor.—  Heparin prevent the activation of the intrinsic coagulation pathway, inhibits the thrombin-mediated conversion of fibrinogen to fibrin, and at high dosages inhibits the aggregation of platelets. Uncommonly, thrombocytopenia can occur.¹ Bleeding complicates the use of heparin in 3% to 33% of patients, an incidence higher than that occurring with the use of oral anticoagulants.²Careful review of the English language medical literature failed to disclose a report of a spinal epidural hematoma complicating the use of heparin, unless a previous spinal tap had been performed.^3,4 There have been two case reports describing the development of spinal epidural hematomas following lumbar puncture. In both, the procedure was performed shortly before starting heparin administration.^3.4

Report of a Case.—  A 21-year-old man was admitted to a Tucson, Ariz, hospital in July 1973 with thrombophlebitis of the lower extremities, a condition that had been recurrent and complicated