Perm Percutaneous Leads in a warfarin pt?

[Timeoutofmind]

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Hi all:

In fellowship, we would send warfarin or even ASA/Plavix people for paddle leads.

The thought process being that perc leads have a higher chance of moving than the paddle, and if that occurred when the pt was anticoagulated, say even a few months after the implant, it could lead to a hematoma.

Obvsiouly, the paddle lead is more invasive, and so I try and place perc leads for people when I can.

What is your practice in these pts?

 

[Agast]

How funny, I just had a lady leave my office whose percutaneous leads were revised twice by other physician, on chronic Coumadin.

 

[studentologist]

We do SCS trials and perms in patients who are on chronic anticoagulation, and follow ASRA guidelines. The patient must hold the medication for the correct amount of time and must restart at the correct time. I’ve talked about this topic with other docs — I think the main source of the bleeding is at the access site of the epidural space, which is punctured during loss of resistance with the touy/coude or manipulated during removal of the leads.

 

[lobelsteve]

Just dont like my options for paddle placement. Lead migration reduced with shallow angle approach and experience. Hold coumadin, do surgery.

 

[Aether2000]

Agree with Steve. In my state, there are no caps on malpractice nor any lack of angry hostile curmudgeons from NY, CT, PA and NJ to sue doctors.

 

[Ronin1]

I follow the latest anticoagulation guidelines and usually place
Percutaneous leads. Paddles only for cases that I have difficulty with placement with during the trial

 

[lobelsteve]

Implanted a guy recently who was only off Plavix x5 days. Riskier to defend. But actual risk approaches 1/1000 for epidural hematoma at that point.

 

[gdub25]

Risk of hematoma with paddle placement was as high as 0.5% I thought. Seems higher risk to send patients who are abticiagulated for paddle, even for the theoretical risk of lead migration down the road causing problems. I had an epidural hematoma two weeks ago with a trial, first I’ve ever seen personally, and with that whole situation I made a lot of calls and got a lot of advice. I talked to a lot of experienced docs and reps and of the group there had only been three personal experiences with this, two of which were with paddles.

 

[BobBarker]

Was he taking herbal supplements?