Haemostasis and safety measures before lumbar puncture in the haematology ward: the Danish routines

Abstract

Background/aims: Thrombocytopenia and the increasing use and variety of antithrombotic drugs is a challenge prior to lumbar puncture. This study examined the Danish haematology practice regarding drug pausation, assessment of haemostasis and whether fundoscopy is a routine safety measure.

Methods: An online survey with questions pertaining to precautions of haemostasis and application of fundoscopy was sent by e-mail to all 12 haematology wards in Denmark.

Results: Eleven sites participated. Five (45%) reported no pausation of antiplatelet drugs at all. The mean platelet limit prior to lumbar puncture was 50 × 10(9)/l (range 10-50 × 10(9)/l). Seven (64%) sites had an international normalised ratio limit of 1.5, and the remaining 4 had values between 1.0 and 2.5. Two (18%) reported occasional use of thromboelastography or platelet analysis to assess the bleeding risk. Fundoscopy is routinely performed in 4 (36%) departments.

Conclusion: We report considerable variation in the routine handling of antithrombotics and thrombocytopenia in patients set for lumbar puncture in Danish haematology departments. The diversity may be explained by and related to different opinions in the literature. Common national guidelines are warranted and there is a need for studies to establish an evidence-based approach for the management of patients at risk of bleeding when lumbar puncture or another invasive procedure is indicated.