Abstract No. 707 A retrospective, descriptive study of hemorrhagic complications associated with fluoroscopy-guided lumbar puncture: a single-institution experience

Abstract

Multiple case reports have presented spinal hematoma and other hemorrhagic complications associated with lumbar puncture (LP). However, the rate of hemorrhagic complications in the setting of fluoroscopy-guided LP remains ill-defined. The purpose of this study was to assess the rate of hemorrhagic complications after fluoroscopy-guided LP overall and in patients on aspirin and/or clopidogrel at a single institution. A retrospective review was performed for patients receiving fluoroscopy-guided lumbar puncture by interventional radiology between March 2015 and August 2017. Patient demographics, aspirin/clopidogrel status, pre-procedure labs (INR, PTT and platelets) and hemorrhagic complications were documented. Hemorrhagic complications assessed were defined as post-LP pRBC transfusion, epidural hematoma, increase in level care and 30-day LP related death. Eight hundred and ninety-six patients with a mean age of 53.9 (±19.6) underwent 1155 LPs, 908 (78.6%) of which were performed on patients not on aspirin or clopidogrel. 223 (19.3%), 9 (0.8%), and 15 (1.3%) LPs were performed on patients on aspirin, clopidogrel and aspirin and clopidogrel, respectively. The majority of available pre-procedure INR, PTT and platelet findings fell within normal ranges. Of patients on aspirin, aspirin was not withheld prior to LP in 219 (98.2%) cases. Clopidogrel was withheld prior LP in all cases involving patients on clopidogrel alone. Regarding LPs for patients on both aspirin and clopidogrel, aspirin was withheld in 4 (26.7%) cases, while clopidogrel was withheld 14 (93.4%) cases. In 1155 LPs, there were no hemorrhagic complications. Hemorrhagic complications after fluoroscopic guided LP is very rare overall and also in patients on anti-platelet therapy with aspirin, clopidogrel, and both. This may indicate that delaying fluoroscopic LP due to aspirin or clopidogrel may be deleterious as it may delay necessary diagnosis and treatment.