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Epidural Abscess Caused Paralysis. Is It Safe To Take Fragmin Along With Warfarin?

Posted on Tue, 12 Mar 2013

Question: I am researching the possibility that Dalteparin Sodium (Fragmin), along with warfarin could have any connection to the paralysis to my son, caused by an Epidural Abscess. I think the coincidence is compelling.

Answered by Dr. Gopal Krishna Dash (18 minutes later)

Hello,
Thanks for posting this query in XXXXXXX

Before I respond your query, let me tell you that when used in combination,(Fragmin+ warfarin) some people can have increased bleeding tendency. This can be easily picked up by clinical examination (patient will have bleeding into skin, eyes etc). Unfortunately, some people may develop bleed into the brain too. However, the risk is not high if used properly.

There is no connection of epidural abscess and these medicines. There could be a remote possibility of bleed into the spinal cord, which may sometimes present with paralysis of legs.

Please understand that these side effects are rare and can be further minimized by a regular follow-up with your doctor.

Please consult a local neurologist who will help you find out the exact cause of epidural abscess so that the treatment will be easy

I hope that I have clarified your query.
In case any further questions, I request you to get back to me.

Best wishes

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Gopal Krishna Dash (14 hours later)

An "Important Warning" published by nlm.nih/medlineplus/druginfo/meds, states if you have epidural or spinal anesthesia or a spinal puncture while taking a "blood thinner" such as dalteparin, you are at risk for XXXXXXX bleeding that could cause you to become paralyzed so the remote possibility of bleed into the spinal cord may sometimes present with paralysis of legs. The warfarin level was found to be too high at one check. He has had rectal cancer, now a permanent colostomy, a permanent catheter, Pancreatitis culminating in diabetes, pressure wounds, an ear infection to the bone that was not treated for 9 months since infection onset and a reaction to contrast XXXXXXX The infection was never identified in the epidural abscess. So I believe, even though you state it's a remote possibility, that bleed into the spinal cord sometimes presents with paralysis of legs following use of Dalteparin. My follow up question is do you believe there could have been unforeseen consequences with the use of Dalteparin and the eventual paralysis as a known secondary issue? I am writing a claims letter and was told to ask another doctor per the above.

Answered by Dr. Gopal Krishna Dash (3 hours later)

Hello,

Thanks a lot for the feed back.

I agree with the statement that while on blood thinner such as deltaparin, you are at increased risk of XXXXXXX bleed. But this largely depend upon the the dose of the medication. This depends upon why this medicine was used for a particular case. For example if blood thinner was used just for prophylaxis of XXXXXXX venous thrombosis, the risk is low where as if it is used for therapeutic purpose, the risk may be high. Further, the risk of bleed in a given individual depends upon the associated medical conditions. The patients with XXXXXXX malignancy/liver problem/blood diseases have a high risk of bleed than patients with other medical problem.

The data that you have posted suggest that the cause of paralysis in your son is related to epidural abscess. Risk factors include an impaired immune status (diabetes mellitus, renal failure, malignancy etc ), intravenous drug abuse, and infections of the skin or other tissues. Two-thirds of epidural infections result from hematogenous spread of bacteria from the skin (furunculosis), soft tissue (pharyngeal or dental abscesses), or XXXXXXX viscera (bacterial endocarditis). The remainder arise from direct extension of a local infection to the subdural space; examples of local predisposing conditions are vertebral osteomyelitis, decubitus ulcers, lumbar puncture, epidural anesthesia, or spinal surgery. With due respect to your emotions, I feel that my previous response has clarified what you want to ask in the follow-up.

Best wishes

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Gopal Krishna Dash (4 hours later)

Thank you so much. I have additional information re a lumbar puncture, epidural anesthesia just 4 days previously and the fact that he had incurred sepsis when he was admitted & had emergency surgery. I appreciate your research and your knowledge. Thanks again.

Answered by Dr. Gopal Krishna Dash (16 hours later)

Hello,

Thanks for the feed back

I wish you the best

Please get back to me if you have any concern

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Shanthi.E