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Updated: May 30, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
A prospective evaluation of bleeding risk of interventional techniques in chronic pain
Laxmaiah Manchikanti1, Yogesh Malla, Bradley W Wargo
1Pain Management Center of Paducah, Paducah, KY, USA. drlm@thepainmd.com
Insights
Continuing antithrombotic therapy during interventional pain management did not significantly increase adverse events compared to cessation. This study suggests that stopping these medications may not be necessary for all patients undergoing procedures.
Area of Science:
- Cardiovascular medicine
- Pain management
- Interventional procedures
Background:
- Antithrombotic therapy is crucial for preventing cardiovascular events.
- Discontinuing antiplatelet therapy before procedures increases thrombosis risk.
- Current practice often involves stopping antithrombotics, potentially raising event risk.
Purpose of the Study:
- To evaluate adverse event rates in patients undergoing interventional techniques.
- To compare outcomes between continuing and discontinuing antithrombotic therapy.
- To assess risks versus benefits of antithrombotic therapy during procedures.
Main Methods:
- Prospective observational study of 3,179 patients (12,000 encounters).
- Data collected from May 2008 to December 2009 in a US pain management practice.
- Outcomes included bleeding, bruising, hematoma, and soreness, analyzed per STROBE guidelines.
Main Results:
- Antithrombotic therapy was used in 25% of encounters.
- Continued therapy (55%) showed higher intravascular entry and oozing.
- Discontinued therapy (45%) showed higher bruising and local bleeding, with no significant clinical differences in other adverse events.
Conclusions:
- No significant difference in adverse events was found between continuing and ceasing antithrombotic therapy.
- The study highlights the need to re-evaluate routine cessation of antithrombotics.
- Limitations include observational design and restricted antiplatelet agents (aspirin, clopidogrel).
Background:
The role of antithrombotic therapy is well known for primary and secondary prevention of cardiovascular disease to decrease the incidence of acute cerebral and cardiovascular events. Data shows that the risk of coronary thrombosis after antiplatelet drug withdrawal is much higher than that of surgical bleeding if the antiplatelet drug therapy were continued. However, it has been a common practice to discontinue antiplatelet therapy prior to performing interventional techniques, which may potentially increase the risk of acute cerebral and cardiovascular events.
Study Design:
A prospective study of 3,179 patients undergoing interventional techniques with 12,000 encounters and 18,472 procedures from May 2008 to December 2009.
Study Setting:
An interventional pain management practice, a specialty referral center, a private practice setting in the United States.
Objective:
To assess the rates of adverse events in patients undergoing interventional techniques on antithrombotic therapy with cessation or without cessation and compare them to a group of patients without antithrombotic therapy.
Methods:
Measurable outcomes employed were intravascular entry of the needle, bruising, local bleeding, profuse bleeding, local hematoma, oozing, and postoperative soreness.The prospective evaluation was performed utilizing the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement which was developed with recommendations to improve the quality of reporting observational studies.
Results:
The results of this study illustrated that in one-quarter (3,087) of patient encounters utilizing interventional pain management techniques, antithrombotic therapy was included. Among these, for approximately 55%, or 1,711 encounters, antithrombotic therapy was continued during the interventional techniques, whereas, for 45%, or 1376 encounters, antithrombotic therapy was discontinued. Overall, these results illustrate that while intravascular penetration and oozing were higher in patients with continued antithrombotic therapy, bruising and local bleeding were higher in patients with discontinued antithrombotic therapy without any difference either statistical or clinical in any of the other aspects, either intraoperative, post procedure in the recovery room, or postoperative period.
Limitations:
Limitations include the nonrandomized observational nature of the study and that antiplatelet therapy was limited to aspirin and clopidogrel (Plavix).
Conclusion:
No significant prevalence of adverse events was observed in those who continued with or ceased antithrombotic therapy.
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