Safety of lumbar puncture in patients on antiplatelet therapy: A real-world study assessing red blood cell counts in cerebrospinal fluid

Objective Elevated cerebrospinal fluid red blood cell counts in patients on antiplatelet therapy during lumbar puncture raise concerns about increased bleeding risk. This study investigated whether antiplatelet therapy potentiates bleeding from inadvertent small-vessel injury during lumbar puncture. Methods This retrospective, real-world study analyzed data from hospitalized patients who underwent lumbar puncture between January 2013 and December 2022. After applying exclusion criteria and data preprocessing, univariate and multivariate logistic regression analyses were conducted to identify factors associated with cerebrospinal fluid red blood cell counts, focusing on perioperative antiplatelet therapy. Additional adverse events were recorded and analyzed. Results Among 1677 patients included (55.22% male; median age, 53 (interquartile range, 39–67) years; median body mass index, 22.65 (interquartile range, 20.41–24.97) kg/m 2 ; 368 (21.94%) patients receiving antiplatelet therapy), red blood cells were observed in 728 (43.4%) patients. Multivariate analysis revealed that older age (odds ratio, 1.01; 95% confidence interval, 1.00–1.01; p = 0.005) was associated with a higher likelihood of red blood cell presence, whereas antiplatelet therapy ( p > 0.05) was not. The incidence of adverse events was comparable between patients receiving and those not receiving antiplatelet therapy (5.57% vs. 4.22%). Conclusions Perioperative antiplatelet therapy was not independently associated with an increased risk of red blood cell presence following lumbar puncture, and adverse event rates were comparable regardless of antiplatelet therapy, suggesting a favorable safety profile in real-world practice.