Is thrombocytopenia a contraindication for epidural?

Thrombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma.

What drug is the most common cause of induced thrombocytopenia?

Heparin, a blood thinner, is the most common cause of drug-induced immune thrombocytopenia. If a medicine prevents your bone marrow from making enough platelets, the condition is called drug-induced nonimmune thrombocytopenia.

What is the threshold below which thrombocytopenia may prevent a patient from receiving epidural anesthesia?

One authority recommends that epidural analgesia be avoided in patients with a low platelet count. ‘ The author suggests a platelet count of 100 x lOP/litre as a lower safe limit in patients with pre-eclamptic toxaemia, but for healthy patients no specific number is given.

When is epidural contraindicated?

Contraindications to the use of a neuraxial (i.e., epidural or subarachnoid) technique include patient refusal, active maternal hemorrhage, septicemia, infection at or near the site of needle insertion and clinical signs of coagulopathy (Table 2).

Does gestational thrombocytopenia affect the baby?

The physiological thrombocytopenia of pregnancy is mild and has no adverse effects for the mother and fetus. By contrast, a significant thrombocytopenia associated with medical conditions can have serious maternal-fetal consequences and requires specific monitoring and appropriate management.

When are platelets too low in pregnancy?

Gestational thrombocytopenia is usually a natural part of pregnancy. Your doctor will monitor your platelets throughout your pregnancy, and recommend any needed treatments. If your platelet count falls below 80,000 per microliter of blood, your thrombocytopenia may be caused by something else.

Why does thrombocytopenia occur in preeclampsia?

Thrombocytopenia is the most frequently detected coagulation disorder in pre-eclampsia and likely occurs as a result of the injured endothelium activating platelets, leading to elevated consumption of platelets [3, 4].

Is drug induced thrombocytopenia reversible?

Treatment of DITP involves discontinuation of the offending drug. The platelet count usually starts to recover after 4 or 5 half-lives of the responsible drug or drug metabolite.

Does drug induced thrombocytopenia go away?

Drug-dependent antibodies can persist for many years, and patients must be advised to avoid the drug that caused thrombocytopenia indefinitely. For example, acute quinine-induced thrombocytopenia can occur even if the patients have not taken quinine for over 10 years.

What is the minimum platelet count for surgery?

Guidelines often recommend a platelet count threshold of 50 x 109/L prior to major surgery and 100 x 109/L prior to surgery involving the brain or eyes (Estcourt 2017; Kaufman 2015; NICE 2015). Guidelines often do not go into further detail about risks for different types of surgery.