Hematoma After a Fluoroscopically Guided Sacroiliac Joint Injection: A Case Report

Background: Sacroiliac joint injection continues to play a role in the diagnosis and therapeutic management of patients with sacroiliac joint arthropathy, as it provides pain relief and improvement in function to those patients. It is considered a low-risk pain procedure with minimal to no adverse side effects. Although rare, serious com-plications such as infection and hematoma are a possibility, however. In anticoagulated patients, interventional pain physicians are advised to weigh the risks and benefits before discontinuing anticoagulation. The literature describes serious complications associated with stopping anticoagulation, such as myocardial infarction. Howev-er, we should also be mindful of the possibility of intramuscular hematoma formation in anticoagulated patients receiving a fluoroscopically guided sacroiliac joint injection. Case Report: This case exposes the development of a 300-mL hematoma in the right gluteus maximus muscle after a fluoro-scopically guided sacroiliac joint injection in a patient who was taking warfarin. Consequently, she also developed neurologic symptoms such as new-onset urinary retention, weakness, and decreased sensation in her right leg. Conclusion: Pain physicians should be mindful of the risks and benefits before deciding to hold or discontinue anticoagulation in patients undergoing fluoroscopically guided sacroiliac joint injection, as intramuscular hematomas are a possible complication. Key words: Anticoagulation, hematoma, sacroiliac joint arthropathy, sacroiliac joint injection complications

Inadvertent Discogram During Lumbar Interlaminar Epidural Steroid Injection

Background: Interlaminar epidural steroid injections (ILESI) are the most common injection performed for lumbosacral radicular pain. In order to continually improve the performance and safety profile of ILESI, it is imperative to report complications and inadvertent outcomes in addition to studies on efficacy in order to create guidelines to mitigate risk of potential debilitating sequelae. Case Report: Here we present a case report of a 36-year-old man who underwent a right sided ILESI for right sided lumbosacral radicular pain from a disc herniation. Following the injection, he had complete resolution of right sided symptoms. However, 4 weeks later he developed left sided lumbosacral radicular for which he underwent repeat left sided ILESI that resulted in an inadvertent discogram. Following this procedure a new magnetic resonance image was obtained that revealed a new large left L5-S1 paracentral extrusion with caudal migration of disc material abutting the ligamentum flavum in the path of the left-sided injection attempt. The patient was treated with oral antibiotics and suffered no significant sequelae from the inadvertent discogram. Conclusions: Discogram during ILESI is a highly unusual and rare complication. We discuss the management and prevention of this complication and review the limited existing literature. Key words: Anticoagulation guidelines, direct thrombin inhibitors, interventional pain, interventional spine, ischemic pain, neuromodulation

Venous Thromboembolism and Transfusion Medicine

Venous thromboembolism (VTE) and transfusion medicine are frequently encountered issues in the intensive care unit. VTE can significantly worsen the risk of morbidity and mortality in any hospitalized patient, but proper preventive measures can reduce its incidence. Blood product transfusions can be lifesaving in appropriate situations but can also be both medically and economically detrimental if used without proper clinical judgment. In this review, we present an overview of VTE diagnosis, pharmacologic and mechanical prophylaxis, and treatment. Additionally, we review current indications for blood product use in various clinical situations, basics of massive transfusions, and adverse medical reactions to transfusions. This review contains 2 figures, 6 tables, and 50 references. Key Words: anticoagulation, blood component separation, venous thrombosis, immunohematology, massive transfusion, superficial venous thrombosis, transfusion threshold, venous thromboembolism

Piyavit from the Medicinal Leech Is a New Orally Active Anticoagulating and Antithrombotic Drug

Piyavit, a novel pharmacological preparation allowed in Russia as an oral antithrombotic drug for clinical use, contains medicinal leech saliva as the main source of biologically active substances that inhibit platelet-vascular and plasmic hemostasis and provide thrombolysis. It is shown that piyavit administered orally or subcutaneously to animals inhibits arterial thrombus formation. In 22 patients with acquired heart valvular disease after implantation of a cardiac artificial valve who received oral piyavit capsules and phenilin 2-3 days after the operation, blood hypercoagulability was reduced in comparison to that of 20 patients after the same type of operation who received only phenilin. An antiinflammatory effect and decreased blood hypercoagulability were observed in 38 patients with thrombophlebitis of the greater saphenous vein who received the same piyavit capsules orally. The results confirm that piyavit as an oral anticoagulant and antithrombotic drug may be an alternative to known antithrombotic preparations. Key Words: Anticoagulation—Antithrombotic drug—Leech saliva— Medicinal leech-Piyavit.