Anticoagulation Management During a Spinal Cord Stimulator Trial on a Patient With ST-Elevation Myocardial Infarction

BACKGROUND: Spinal cord stimulators (SCSs) are indicated for the treatment of many pain syndromes. They are often trialed prior to placement of a permanent implant. Patients on anticoagulation therapy are instructed to follow the American Society of Regional Anesthesia and Pain Medicine guidelines during this process. CASE REPORT: Here we describe a unique case of a patient who had an SCS trial, followed by an ST-elevation myocardial infarction (STEMI) on day 4 postimplantation. After coronary revascularization, the patient started dual antiplatelet therapy, which posed significant for epidural hematoma with recent stimulator implantation. CONCLUSIONS: The patient was bridged with intravenous antiplatelet agents prior to SCS trial removal and monitored closely. Our discussion will focus on all anticoagulation management of patients with a recent STEMI who had undergone a trial SCS implantation.