Hold it to be "safe": Anticoagulant and antiplatelet management before lumbar radiofrequency neurotomy

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Patients on anticoagulant or antiplatelet therapy undergoing lumbar radiofrequency neurotomy. Intervention: Continuation of anticoagulant and antiplatelet therapy vs. Interruption of anticoagulant and antiplatelet therapy.

David Hao; Jay V. Karri

doi:10.1016/j.inpm.2026.100812

August 25, 2026Interventional Pain MedicineOpen Access

Hold it to be "safe": Anticoagulant and antiplatelet management before lumbar radiofrequency neurotomy

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Key result

Routine periprocedural interruption of anticoagulant and antiplatelet medications for lumbar radiofrequency neurotomy increases thromboembolic risks without providing significant hemostatic benefit.

Why the study?

Does continuation of anticoagulant and antiplatelet therapy prevent thromboembolic events without increasing major bleeding in patients undergoing lumbar radiofrequency neurotomy?

Key Points

To examine the clinical and anatomical rationale for continuing versus interrupting anticoagulant and antiplatelet therapy prior to lumbar radiofrequency neurotomy.
Reviewed spinal anatomy and needle trajectory under multiplanar fluoroscopy during lumbar radiofrequency neurotomy.
Synthesized evidence from prospective cohort studies evaluating bleeding and ischemic outcomes alongside recommendations from multi-society clinical guidelines.
Across 145 patients undergoing lumbar RFN while maintained on warfarin (32.4%), clopidogrel (38.6%), apixaban (31.7%), or rivaroxaban (4.1%), the prevalence of hemorrhagic complications was zero (95% CI: 0 - 0.3 percent).
In a series of more than 6000 procedures, ischemic complications occurred in 0.66% when medications were stopped versus 0.39% when continued, with drug cessation leading to five non-fatal strokes, one myocardial infarction, one pulmonary embolism, and two deaths.
Stopping warfarin carries an estimated 0.4 to 0.5 percent risk of serious cardiovascular or cerebrovascular events (range 0.2 to 0.9 percent), supporting ASRA and ASIPP classifications of lumbar RFN as a low-risk procedure not requiring routine drug cessation.

Structured PICO

Does continuation of anticoagulant and antiplatelet therapy prevent thromboembolic events without increasing major bleeding in patients undergoing lumbar radiofrequency neurotomy?

P

Population

Patients taking anticoagulant and/or antiplatelet medications scheduled for low-risk interventional spine procedures, specifically lumbar radiofrequency neurotomy (RFN).

I

Intervention

Continuation of anticoagulant and/or antiplatelet therapy (e.g., warfarin, clopidogrel, apixaban, rivaroxaban, aspirin).

C

Comparator

Interruption (holding) of anticoagulant and/or antiplatelet therapy.

O

Outcome

Major bleeding events (e.g., neuraxial hematomas) and thromboembolic events (e.g., stroke, myocardial infarction, death).safety

Limitations

Paucity of large outcome studies requiring society guidelines to rely on low to moderate certainty evidence
Discordant recommendations among existing consensus guidelines regarding specific agents and procedure classifications
Subjective decision-making heavily influenced by recall bias of vivid bleeding events versus delayed thromboembolic events

Implication

Continuing anticoagulation and antiplatelet therapies during low-risk interventional spine procedures like lumbar RFN mitigates the risk of severe cardiovascular events without conferring significant bleeding risk.

Abstract

Hold it to be "safe": Anticoagulant and antiplatelet management before lumbar radiofrequency neurotomy 1. "Hold it to be safe": Anticoagulant and antiplatelet management before lumbar radiofrequency neurotomy

Discussion

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Cite This Study

Hao et al. (2026) conducted an editorial in Patients on anticoagulant or antiplatelet therapy undergoing lumbar radiofrequency neurotomy. Continuation of anticoagulant and antiplatelet therapy vs. Interruption of anticoagulant and antiplatelet therapy was evaluated. Routine periprocedural interruption of anticoagulant and antiplatelet medications for lumbar radiofrequency neurotomy increases thromboembolic risks without providing significant hemostatic benefit.

synapsesocial.com/papers/6ad0fcc53afa093ea9acfff9 https://doi.org/10.1016/j.inpm.2026.100812

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Hold it to be "safe": Anticoagulant and antiplatelet management before lumbar radiofrequency neurotomy

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Hold it to be "safe": Anticoagulant and antiplatelet management before lumbar radiofrequency neurotomy

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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