Risks and Benefits of Ceasing or Continuing Anticoagulant Medication for Image-Guided Procedures for Spine Pain: A...

Area of Science:

• Pain Management
• Interventional Procedures
• Pharmacology

Background:

• Image-guided spine procedures are common for pain management.
• Patients undergoing these procedures may be on anticoagulant or antiplatelet therapy.
• Managing these medications around procedures is critical to balance bleeding and clotting risks.

Purpose of the Study:

• To evaluate the risks of continuing or stopping anticoagulant/antiplatelet medications before image-guided spine pain procedures.
• To inform clinical guidelines regarding medication management for these interventions.

Main Methods:

• Systematic literature review and comprehensive analysis of published data.
• Appraisal of studies by seven reviewers assessing evidence quality.
• Evaluation of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system.

Main Results:

• 14 articles provided applicable evidence from 120 initially identified.
• Interlaminar access procedures have a risk of bleeding, irrespective of medication management.
• Other procedures appear safe when anticoagulants are continued; stopping them carries serious risks, including death.

Conclusions:

• Evidence does not support routine cessation of anticoagulant/antiplatelet therapy for most image-guided spine procedures.
• Stopping anticoagulants poses significant risks, including potentially fatal outcomes.
• Clinical guidelines should be updated to reflect the evidence on medication management for these procedures.