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

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.

Keywords: Anticoagulant; Facet Intervention; medial branch blocks.