Safety of lumbar puncture for people who are treated with ADP receptor antagonists

Area of Science:

• Neurology
• Cardiology
• Clinical Practice Guidelines

Background:

• Current guidelines recommend discontinuing adenosine-diphosphate receptor antagonists (ADPra) 7 days before lumbar puncture (LP).
• This practice may delay diagnosis of neurological emergencies and increase cardiovascular risk.
• This study evaluated LP safety without ADPra discontinuation.

Purpose of the Study:

• To assess the safety of performing lumbar puncture (LP) without discontinuing adenosine-diphosphate receptor antagonists (ADPra).
• To evaluate the incidence of complications, specifically traumatic taps, in patients undergoing LP while on ADPra.
• To compare complication rates with control groups on aspirin or no antiplatelet therapy.

Main Methods:

• Retrospective case series of patients undergoing LP with uninterrupted or briefly interrupted ADPra.
• Medical records were reviewed for complications, with traumatic tap defined by cerebrospinal fluid red cell count ≥ 1000 cells/μL.
• Incidence of traumatic tap was compared between patients on ADPra, aspirin, and no antiplatelet therapy.

Main Results:

• 159 patients underwent LP under ADPra, with 116 procedures performed without interruption.
• The incidence of traumatic tap was 5% in the ADPra group, 5.7% in the aspirin group, and 2.5% in the no antiplatelet group (P=0.35).
• No spinal hematomas or neurological deficits were reported in any patient.

Conclusions:

• Lumbar puncture can be safely performed without discontinuing adenosine-diphosphate receptor antagonists (ADPra).
• These findings support a potential revision of current guidelines.
• Further case series may provide additional evidence to support guideline changes.