Antiplatelet therapy is not associated with increased risk of complications after lumbar puncture

Lumbar puncture (LP) is a critical diagnostic procedure in the evaluation of neurological diseases. Although considered safe, complications such as post-dural puncture headache (PDPH), back pain, subdural hematoma or venous sinus thrombosis may still occur. Whether the use of antiplatelet therapy (APT) increases the risk of complications after LP, remains unclear.

This retrospective observational study included 783 patients who underwent diagnostic LP. We employed multivariate logistic regression models with complications as the dependent variable, and APT as the independent variable, adjusting for potential confounders.

Among 783 patients included (54.0% female, median age 48 years [IQR 33-64], median BMI 24.7 kg/m² [IQR 21.8-28.3], 111 [14.2%] receiving APT), complications were observed in 182 (23.2%) patients. The most common complications were PDPH and back pain in 152 (19.4%) and 42 (5.4%) patients, respectively. Venous sinus thrombosis occurred in one (0.1%) patient. In the multivariate logistic regression model, younger age (OR 1.49 per 10 years, 95% CI 1.32-1.69, p < 0.001) and female sex (OR 1.74, 95% CI 1.19-2.54, p = 0.005) were associated with higher likelihood of complications, whereas APT (OR 0.63, 95% CI 0.30-1.36, p = 0.241) and the final diagnosis were not.

Complications following LP occur in approximately one fourth of patients, with younger age and female sex being significant risk factors. As APT is not associated with increased risk of complications, withholding LP in patients on APT may not be necessary.