Considerations When Performing an Epidural Blood Patch on a Patient Anticoagulated with Low Molecular Weight Heparin: A Case Report

BACKGROUND: Epidural blood patch (EBP) procedure timing can be difficult in patients on anticoagulant therapy when balancing the goals of EBP, safety, and efficacy. CASE REPORT: We present the case of a patient on anticoagulant therapy with low molecular weight heparin (LMWH) who presented for a planned cesarean section which was complicated by dural puncture with a Tuohy needle during combined spinal-epidural placement. She then developed a postdural puncture headache (PDPH) after restarting LMWH. After holding LMWH for 18 hours, an EBP was placed resulting in symptomatic relief; LMWH was restarted 12 hours later. However, her symptoms returned and EBP was repeated 78 hours after the initial blood patch, again with relief of symptoms. CONCLUSION: This case highlights the importance of EBP procedure timing in the setting of LMWH administration in order to maximize efficacy while minimizing neuraxial hematoma and venous thromboembolism risk. KEY WORDS: Epidural blood patch, postdural puncture headache, anticoagulation, efficacy, timing