Why the study?
Does withholding antithrombotics prior to lumbar interventional pain procedures affect the risk of hemorrhage versus cardiovascular events?
Does withholding antithrombotics prior to lumbar interventional pain procedures affect the risk of hemorrhage versus cardiovascular events?
The decision to withhold antithrombotics for lumbar pain procedures must balance the theoretical risk of hemorrhage against the real risk of cardiovascular events upon discontinuation.
May warrant continuing antithrombotics for lumbar radiofrequency neurotomy to reduce cardiovascular events; challenges prior emphasis on periprocedural discontinuation.
This series of FactFinders presents a brief summary of the evidence and outlines recommendations regarding the safety of antithrombotics and two interventional pain procedures - lumbar transforaminal epidural steroid injections and lumbar medial branch radiofrequency neurotomy. The evidence in support of the following facts is presented: (1) The decision to withhold antiplatelet therapy prior to lumbar transforaminal epidural steroid injections should be made on a case-by-case basis, weighing the relative risk of hemorrhage versus the risk of thrombosis for each patient. (2) A clinically significant hemorrhagic complication has never been reported in the medical literature in association with a lumbar medial branch radiofrequency neurotomy procedure. (3) Discontinuing antithrombotics for lumbar radiofrequency neurotomy procedures, even for a short period of time, may lead to an increased incidence of cardiovascular and cerebrovascular events.
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Smith et al. (2021) studied this question.
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