Difference between revisions of "SPINE INJECTION-BLEEDING RISK"

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==Reference(s)==
==Reference(s)==
<references />
<references />
<br/>Furman, Michael B., and Leland Berkwits. Atlas of Image-Guided Spinal Procedures. Elsevier, Inc, 2017.
<br/>Horowitz AL. MRI Physics for Physicians. Springer Science & Business Media. (1989) ISBN:1468403338.
<br/>Mangrum W, Christianson K, Duncan S et-al. Duke Review of MRI Principles. Mosby. (2012) ISBN:1455700843.


[[Category:Spine Injection]]
[[Category:Spine Injection]]
[[Category:Radiology]]
[[Category:Radiology]]
[[Category:Radiology]]
[[Category:Radiology]]

Latest revision as of 12:18, 25 April 2023

SUMMARY

1. Coagulopathy: epidural hematoma risk is rather low (1 in 70,000 to 1 in 190,000)[1][2]. However, severe morbidity such as paraparesis or quadriparesis can be associated with an epidural hematoma.

2. NSAIDs: including aspirin, reduce platelet aggregation, but have not been implicated in increased bleeding risk or complications in lumbar epidural injections[3].

3. Antiplatelet medication: based on labeling precautions, surgical literature, and interventional cardiology and radiology data, it is recommended clopidogrel be discontinued for 7 days and ticlopidine for 14 days before spinal intervention[4][5].

4. Anticoagulants: warfarin is contraindication for spinal interventions & should be discontinued for 4-5 days before any spinal intervention to allow the PT and INR to normalize. Prophylactic LMWH shoulde be withheld for 12 hrs prior to procedure & and can be immediately recommenced after. Theraputic LMWH should be withheld for 24 hrs prior and 24 hrs after.

5. Prophylactic low-dose unfractionated heparin is not a contraindication for spinal procedures[6]. Therapeutic heparin should be discontinued 2-4 hrs before any spinal procedure and a normal APTT documented before; can be recommenced 1 hr after the procedure[7].


Reference(s)

  1. Abram SE, O’Connor TC: Complications associated with epidural steroid injections, Reg Anesth 21(2):149-162, 1996.
  2. Wulf H: Epidural anaesthesia and spinal haematoma, Can J Anaesth 43(12):1260-1271, 1996.
  3. Horlocker TT, Bajwa ZH, Ashraf Z, et al: Risk assessment of hemorrhagic complications associated with nonsteroidal antiinflammatory medications in ambulatory pain clinic patients undergoing epidural steroid injection, Anesth Analg 95(6):1691-1697, 2002.
  4. Kearon C, Hirsh J: Management of anticoagulation before and after elective surgery, N Engl J Med 336(21):1506-1511, 1997.
  5. Layton KF, Kallmes DF, Horlocker TT: Recommendations for anticoagulated patients undergoing image-guided spinal procedures, AJNR Am J Neuroradiol 27(3):468-470, 2006.
  6. Vandermeulen EP, Van Aken H, Vermylen J: Anticoagulants and spinal- epidural anesthesia, Anesth Analg 79(6):1165-1177, 1994.
  7. Liu SS, Mulroy MF: Neuraxial anesthesia and analgesia in the presence of standard heparin, Reg Anesth Pain Med 23(6 suppl 2):157-163, 1998.


Furman, Michael B., and Leland Berkwits. Atlas of Image-Guided Spinal Procedures. Elsevier, Inc, 2017.
Horowitz AL. MRI Physics for Physicians. Springer Science & Business Media. (1989) ISBN:1468403338.
Mangrum W, Christianson K, Duncan S et-al. Duke Review of MRI Principles. Mosby. (2012) ISBN:1455700843.