Abstract Background Lumbar punctures are one of the most used diagnostic and therapeutic procedures for a range of CNS pathologies, including infection and increased intracranial pressure due to many etiologies. Lumbar punctures violate the dura of the thecal sac, posing some risk for the formation of epidural or subdural hematomas. This risk may be increased in patients on anticoagulant or antiplatelet therapy. This study compares the odds of developing epidural or subdural hematomas, paralysis, and the requirement of epidural blood for hemostasis within 30 days of lumbar puncture in patients with and without anticoagulant or antiplatelet use in hopes of establishing evidence-based guidelines for clinical decision-making for lumbar punctures in patients using these medications. Methods The TriNetX multi-institutional electronic health record database was used to perform a retrospective, propensity score-matched analysis of outcomes of cohorts of patients who underwent lumbar punctures on anticoagulants, antiplatelets, and no anticoagulants or antiplatelets within one month of the procedure. The outcomes of interest were examined within 30 days of lumbar puncture and included the occurrence of epidural or subdural hematoma, paralysis, requirement of an epidural blood patch, and requirement of spinal decompression. Results A total of 25,788 patients were identified for both lumbar puncture patients with anticoagulants and without blood thinners after propensity score matching. For this study, epidural hematoma (OR 95%CI, 1.000 0.561–1.784) showed no difference in odds ratio between the two cohorts, while subdural hematoma (OR 95%CI, 0.780 0.640–0.950) showed a statistically significantly lower odds ratio for the anticoagulant use group. We identified 13,310 patients for both lumbar puncture patients with antiplatelets and lumbar puncture patients without antiplatelet, anticoagulant, heparin, and LMWH (“blood thinners”) after propensity score matching. For this analysis, epidural hematoma (OR 95%CI, 1.904 0.885–4.095) showed a higher odds ratio compared to subdural hematoma (OR 95%CI, 1.008 0.784–1.296), both of which were not statistically significant. Conclusion The data analyses suggest that there are no increased risks of epidural and subdural hematoma in patients with a history of use of antiplatelet or anticoagulant compared to those who do not. These results could be further validated by a single or multi-institutional retrospective cohort study with additional parameters that characterize the patient population.
Hong et al. (Mon,) studied this question.