AB1578 HEMORRHAGIC RISK ASSOCIATED WITH SPINAL PROCEDURES AND FOCUS ON PATIENTS TREATED BY ANTICOAGULANTS OR PLATELET INHIBITORS: A SYSTEMATIC LITERATURE REVIEW AND META ANALYSIS

Abstract

BackgroundSpinal procedures – including lumbar puncture, radiofrequency neurotomy, medial branch injection, facet joint injection, blood patch and epidural injection – are common in daily practice. Side effects can occur during these invasive procedures like hemorrhagic complications. The use of anticoagulants and platelet inhibitors can increase these risks.ObjectivesThe aim of this study is to characterize the hemorrhagic risk associated with spinal procedures and to analyze if there is a sur risk of bleeding complications in patients treated with anticoagulants or platelet inhibitors.MethodsA systematic literature review and metanalysis were made in MEDLINE, EMBASE and COCHRANE, in order to find a prevalence of hemorrhagic complications for each spinal procedure. We classify hemorrhagic risk in two categories. Bleeding and traumatic procedure were not severe complications and epidural hematoma and central nervous system bleeding were severe complications.ResultsSystematic literature analysis found 2407 articles. 75 were included in the metanalysis. The flow chart diagram, according to the PRISMA criteria is shown [Figure 1]. The global prevalence of each hemorrhagic complication according to each spinal procedure is showed in Table 1. There was no difference between patients with anticoagulants or platelet inhibitors and the others according to the epidural hematoma risk with OR of 0.95 IC95 [0.16-5.52] after a lumbar puncture and for the risk of traumatic lumbar puncture with OR of 0.78 IC95 [0.47-1.29].ConclusionHemorrhagic complications during a percutaneous spinal procedure are very low. These findings are in coherence with precedents findings. In this metanalysis there was no difference between patients with anticoagulants or platelet inhibitors and the others during a lumbar puncture according to the epidural hematoma risk and the traumatic puncture risk. Strength of the study is the very important number of procedures. However studies were very heterogeneous.This metanalysis found that severe bleeding risk is very low during a spinal procedure but consequences can be severe. That is why the use of anticoagulants and platelet inhibitors has to be careful.Figure 1.Table 1.Local bleedingTraumatic punctureEpidural hematomaCentral nervous system bleedingLumbar puncture5/1 614 0% IC95% [0%-1%]1820/10 961 16 % IC95 % [13%-18%]169/96 524 0% IC95% [0%-1%]176/6 347 2% IC95% [0%-9%]Epidural injection78/29 439 0% IC95% [0%-1%]63/597 8% IC95% [0%-20%]22/273 766 0% IC95 % [0%-0%]NABlood patchNANANA11/684 7% IC95% [0%-33%]Facet joint injectionNANA0/8 162 0% IC95 % [0%-0%]NAMedial block branch injection0/3 059 0% IC95% [0%-0%]NA0/920%NARadiofrequency neurotomy1/683 0% IC95% [0%-2%]NA0/162 0% IC95% [0%-0%]NAVertébroplasty/KyphoplastyNANA4/365 1% IC95% [0%-3%]NAREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.