Background: Spinal cord stimulation (SCS) is a rapidly growing interventional treatment modality in chronic pain. Pain
physicians are faced with the decision on how to manage patients on anticoagulation therapy given the
risk of epidural hematomas.
Case Report: We describe a patient with a history of atrial fibrillation and prior pulmonary embolism on chronic anticoagulation.
The patient was planned to undergo an SCS trial, but was unable to discontinue all anticoagulation
during the length of the trial. Utilizing a multidisciplinary approach, the patient discontinued
warfarin 5 days prior to the procedure and began a therapeutic dose of low molecular weight heparin
(LMWH). The final dose of LMWH was given 24 hours before the trial procedure. The patient then started
prophylactic dosing of LMWH 24 hours after the trial procedure and continued that regimen for the course
of the SCS trial. The last dose of prophylactic LMWH was given 24 hours before removal of the trial leads
and the patient restarted 3 days of therapeutic LMWH along with resuming his normal anticoagulation
regimen after lead removal. The patient was able to undergo a successful SCS trial and will be pursuing
a SCS implant with further anticoagulation management.
Conclusion: This case demonstrates a possible strategy for managing patients who requiring anticoagulation therapy
during the course of their SCS trial phase.
Although a single-electrode array proved to be efficacious, using 2 electrode arrays improves the anatomic
coverage of the painful areas and allows for greater optionality in electrode selections to avoid plasticity.
Key words: Spinal cord stimulation, anticoagulation, chronic pain, post laminectomy syndrome
A low-cost interface for multi-electrode array data acquisition systems