{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:20:36Z","timestamp":1783434036261,"version":"3.54.6"},"reference-count":14,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia Reports"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Spinal epidural haematoma after spinal anaesthesia is rare but may cause severe neurological injury. We report the case of an 85\u2010year\u2010old man who developed a delayed thoracic spinal epidural haematoma following uncomplicated single\u2010shot spinal anaesthesia for elective endovascular aortic repair. Low\u2010dose intravenous unfractionated heparin was administered 73\u2009minutes after the spinal puncture. Seventy\u2010two hours after surgery, the patient developed acute bilateral lower\u2010limb weakness, back pain, loss of perineal sensation and urinary retention. Magnetic resonance imaging revealed a posterior thoracic epidural haematoma from T7 to T12; urgent T8\u2013T12 hemilaminectomy was then performed. Despite partial neurological recovery, seven\u2009days later, the patient developed sudden back pain and complete paraplegia. Repeat imaging showed recurrent epidural haematoma from T6 to T12, requiring repeat decompression. Standard coagulation tests and rotational thromboelastometry remained within normal limits throughout admission. Subsequent extended coagulation testing identified reduced factor XIII activity (38%). The patient remained paraplegic with persistent urinary retention after 60\u2009days of rehabilitation. This case illustrates that delayed and recurrent spinal epidural haematoma may occur after atraumatic spinal anaesthesia despite guideline\u2010compliant timing of unfractionated heparin and normal routine coagulation testing. In patients with unexplained delayed or recurrent neuraxial bleeding, occult disorders of clot stability should be considered.<\/jats:p>","DOI":"10.1002\/anr3.70083","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:08:10Z","timestamp":1783433290000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delayed and recurrent thoracic epidural haematoma after spinal anaesthesia in a patient with factor\n                    <scp>XIII<\/scp>\n                    deficiency"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4443-1905","authenticated-orcid":false,"given":"A.","family":"Fioccola","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, ASST Santi Paolo e Carlo San Paolo University Hospital  Milan Italy"},{"name":"Department of Health Sciences University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Pitimada","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, ASST Santi Paolo e Carlo San Paolo University Hospital  Milan Italy"},{"name":"Department of Health Sciences University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Cannav\u00f2","sequence":"additional","affiliation":[{"name":"Complex Operating Unit, Rehabilitation Unit 2 The Milanese Institutes of Martinitt, Stelline and Pio Albergo Trivulzio  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Cabiddu","sequence":"additional","affiliation":[{"name":"Complex Operating Unit, Rehabilitation Unit 2 The Milanese Institutes of Martinitt, Stelline and Pio Albergo Trivulzio  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Filardo","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, ASST Santi Paolo e Carlo San Paolo University Hospital  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Chiumello","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, ASST Santi Paolo e Carlo San Paolo University Hospital  Milan Italy"},{"name":"Department of Health Sciences University of Milan  Milan Italy"},{"name":"Coordinated Research Center on Respiratory Failure University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/00031348251397596"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2020.08.112"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2010.48.3.281"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20102007\u2010998902"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/eja.0000000000001600"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2013.174"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/6729275"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2016.06.002"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8892225"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer381"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8827962"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12245\u2010021\u201000379\u20100"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/tme.12069"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586\u2010005\u20100965\u20108"}],"container-title":["Anaesthesia Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/anr3.70083","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/anr3.70083","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/anr3.70083","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:08:10Z","timestamp":1783433290000},"score":1,"resource":{"primary":{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/10.1002\/anr3.70083"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":14,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/anr3.70083"],"URL":"https:\/\/doi.org\/10.1002\/anr3.70083","archive":["Portico"],"relation":{},"ISSN":["2637-3726","2637-3726"],"issn-type":[{"value":"2637-3726","type":"print"},{"value":"2637-3726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-06-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70083"}}