Related Experiment Video
Updated: Jan 5, 2026
Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model
Published on: June 18, 2021
Intracranial Hemorrhage following Lumbar Puncture in a Patient on Apixaban
Priyanka Vijapura1, Michael J Maniaci1
1Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
Insights
Emergent lumbar puncture in patients on direct oral anticoagulants (DOACs) lacks evidence-based guidelines. A case report highlights subdural hematomas after lumbar puncture in a patient taking apixaban, underscoring bleeding risks.
Area of Science:
- Neurology
- Hematology
- Pharmacology
Background:
- Clinical practice guidelines for emergent lumbar puncture in patients on direct oral anticoagulants (DOACs) are absent, relying on expert opinion.
- Direct oral anticoagulants (DOACs) are increasingly prescribed for conditions like nonvalvular atrial fibrillation.
Observation:
- An 80-year-old female on therapeutic apixaban for atrial fibrillation underwent lumbar puncture for suspected meningitis.
- The patient subsequently developed bilateral subdural hematomas.
Findings:
- This case highlights the potential risk of intracranial hemorrhage, specifically subdural hematomas, following lumbar puncture in patients anticoagulated with DOACs.
- Current criteria for pre-lumbar puncture brain imaging are reviewed in the context of DOAC use.
Implications:
- There is a critical need for evidence-based guidelines on managing emergent lumbar punctures in patients taking DOACs.
- Further research is warranted to establish clear protocols and mitigate bleeding risks associated with lumbar puncture in this patient population.
Abstract:
Currently, clinical practice recommendations regarding patients in need of emergent lumbar puncture who are taking direct oral anticoagulants (DOACs) are based upon expert opinion, as evidence-based guidelines are unavailable. We present the case of an 80-year-old Caucasian lady who underwent diagnostic lumbar puncture for presumed meningitis while on therapeutic apixaban for nonvalvular atrial fibrillation. She was subsequently found to have bilateral subdural hematomas. This case report reviews both the current criteria for computerized tomography brain imaging prior to lumbar puncture as well as the bleeding risks of lumbar puncture while on a DOAC.
