Epidural Hematoma Risks Associated With Ceasing Versus Maintaining Anticoagulant and/or Antiplatelet Medications for Spine Facet Interventions.

Abstract

Facet joint interventions are commonly performed procedures in patients with neck and back pain, including patients managed with anticoagulant/antiplatelet medications. Temporary cessation of anticoagulant/antiplatelet medications may increase the risk of thromboembolic complications, which may be unnecessary. The aim of the study was to determine the risk of clinically relevant hemorrhagic complications in patients undergoing facet interventions. Consecutive patients from September 19, 2009, to June 16, 2017, who were on anticoagulant/antiplatelet medication 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 after procedure. Five hundred eighty-two procedures targeting the cervical, thoracic, or lumbosacral facet joints were performed on patients on anticoagulant or antiplatelet medications. One hundred twenty-eight patients ceased their anticoagulant/antiplatelet medications before the procedure and 454 maintained anticoagulant/antiplatelet medications. No clinically relevant epidural hematomas were noted in the patient cohort (0/582, 0%, 95% confidence interval = 0.0%-0.6%). 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 anticoagulant/antiplatelet medications before cervical thoracic and lumbar facet interventions.