Epidural Hematoma Risks Associated with Ceasing Vs Maintaining Anticoagulant And/or Antiplatelet Medications For Spine Facet Interventions.

IF 2.2 4区医学 Q1 REHABILITATION

American Journal of Physical Medicine & Rehabilitation Pub Date : 2025-06-13 DOI:10.1097/PHM.0000000000002795

Michael B Furman, Gene Tekmyster, Lelia Gilhool, Jesse S Bernstein, Ajay R Kurup, Christopher T Bednarek, Holden M Caplan, Byron Schneider

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引用次数: 0

Abstract

Background: Facet joint interventions are commonly performed procedures in patients with neck and back pain, including patients managed with anticoagulant/antiplatelet medications (ACAP). Temporary cessation of ACAP medications may increase the risk of thromboembolic complications, which may be unnecessary.

Objectives: Determine the risk of clinically relevant hemorrhagic complications in patients undergoing facet interventions.

Methods: Consecutive patients from September 19, 2009-Jun 16, 2017, who were on ACAP medications and scheduled for an any facet intervention in the cervical, thoracic and lumbosacral spine were retrospectively audited for bleeding complications for a minimum of 90 days post-procedure.

Results: 582 procedures targeting the cervical, thoracic, or lumbosacral facet joints were performed on patients on AC or AP medications. 128 patients ceased their ACAP medication prior to the procedure and 454 maintained ACAP medication. No clinically relevant epidural hematomas (EH) were noted in the patient cohort (0/582, 0%, 95% CI 0.0-0.6%).

Discussion/conclusions: The risk of clinically relevant bleeding complications including epidural hematoma in properly performed facet interventions is low. This information is crucial in being able to quantitatively determine the risk of ceasing or maintaining ACAP medications prior to cervical thoracic and lumbar facet interventions.

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硬膜外血肿风险与停止和维持脊柱小关节干预的抗凝和/或抗血小板药物相关

背景：小关节干预通常用于颈背痛患者，包括使用抗凝血/抗血小板药物（ACAP）治疗的患者。暂时停止ACAP药物可能会增加血栓栓塞并发症的风险，这可能是不必要的。目的：确定接受关节突介入治疗的患者发生临床相关出血并发症的风险。方法：2009年9月19日至2017年6月16日，连续接受ACAP药物治疗并计划在颈椎、胸椎和腰骶椎进行任何关节面介入治疗的患者，回顾性审查术后至少90天的出血并发症。结果：582例针对使用AC或AP药物的患者进行了针对颈椎、胸椎或腰骶关节突关节的手术。128例患者在手术前停止ACAP治疗，454例患者继续使用ACAP治疗。患者队列中未发现临床相关的硬膜外血肿（EH）（0/ 582,0%, 95% CI 0-0.6%）。讨论/结论：临床相关出血并发症（包括硬膜外血肿）在适当的关节突干预中发生的风险很低。这一信息对于定量确定在颈椎、胸椎和腰椎关节突干预前停止或维持ACAP药物治疗的风险至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Physical Medicine & Rehabilitation 医学-康复医学

CiteScore

4.60

自引率

6.70%

发文量

423

审稿时长

1 months

期刊介绍： American Journal of Physical Medicine & Rehabilitation focuses on the practice, research and educational aspects of physical medicine and rehabilitation. Monthly issues keep physiatrists up-to-date on the optimal functional restoration of patients with disabilities, physical treatment of neuromuscular impairments, the development of new rehabilitative technologies, and the use of electrodiagnostic studies. The Journal publishes cutting-edge basic and clinical research, clinical case reports and in-depth topical reviews of interest to rehabilitation professionals. Topics include prevention, diagnosis, treatment, and rehabilitation of musculoskeletal conditions, brain injury, spinal cord injury, cardiopulmonary disease, trauma, acute and chronic pain, amputation, prosthetics and orthotics, mobility, gait, and pediatrics as well as areas related to education and administration. Other important areas of interest include cancer rehabilitation, aging, and exercise. The Journal has recently published a series of articles on the topic of outcomes research. This well-established journal is the official scholarly publication of the Association of Academic Physiatrists (AAP).