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Risk of ischemic and hemorrhagic complications associated with continuation versus interruption of antithrombotic
Audrey V Adler1, Daniel C Persson1, Christopher G Leonardi1
1Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
Background:
Cervical transforaminal epidural steroid injections (CTFESI) and cervical selective nerve root blocks (CSNRB) are commonly performed for the diagnosis and treatment of cervical radicular pain. Periprocedural management of antithrombotic therapy remains challenging, requiring a balance between the potential risk of hemorrhagic complications, particularly epidural hematoma, and the risk of thromboembolic complications associated with medication interruption. Although recent evidence suggests a low risk of hemorrhagic complications when antithrombotic therapy is continued during spinal procedures, data specific to cervical transforaminal injections remain limited.
Objective:
To assess the incidence of ischemic and hemorrhagic complications at 0-30 days (primary outcome) and 31-90 days (secondary outcome) post-procedure among patients undergoing CTFESI and CSNRB who continued versus interrupted antithrombotic therapy prior to the procedure.
Methods:
Retrospective chart review of consecutive patients who underwent fluoroscopically-guided CTFESI or CSNRB at a single tertiary academic institution.
Results:
A total of 105 procedures from 95 patients met inclusion criteria. Antithrombotic therapy was continued in 25 procedures (23.8%) and interrupted in 80 procedures (76.2%). No hemorrhagic complications occurred in either group from 0 to 30 days (continued: 0/25, 0.0%, 95% CI 0.0-13.3; interrupted: 0/80, 0.0%, 95% CI 0.0-4.6; p = 1.000). Ischemic complications occurred from 0 to 30 days in 1 procedure in the continued group (1/25, 4.0%, 95% CI 0.7-19.5) and 2 procedures in the interrupted group (2/80, 2.5%, 95% CI 0.7-8.8; p = 0.562). No additional hemorrhagic or ischemic complications occurred between 31 and 90 days in either group.
Conclusion:
No hemorrhagic complications were observed following cervical transforaminal injections when antithrombotic therapy was continued or interrupted, though 3 total ischemic events occurred. Due to the small sample size and low frequency of observed events, this study provides primarily descriptive data on adverse events rather than offering definitive evidence for procedure safety when continuing therapy or comparative ischemic risk between groups. Larger studies are needed to better characterize the risks associated with continuation versus interruption of antithrombotic therapy.
