(AS2) Risk Analysis of Developing Subdural and Epidural Hematoma Following Lumbar Puncture for Patients with History of Antiplatelet and Anticoagulant Use: A Retrospective Cohort Study

Introduction: Lumbar puncture is one of the most performed procedures in diagnosing CNS diseases including but not limited to infections, bleeding, cancer, and genetic abnormalities. The risks associated with lumbar puncture for patients with the use of anticoagulant and antiplatelet have been controversial as they are associated with neurological risks of bleeding such as epidural and subdural hematoma.

Methods: A retrospective data collection was carried out through TriNetX, a database with clinical information from 92 healthcare organizations. The data for patients who had lumbar puncture with history of antiplatelet use and anticoagulant use were collected separately. The outcome of epidural and subdural hematoma was set to start on the day of first occurrence (lumbar puncture) to 30 days after the first occurrence. Propensity score matching was performed to balance the characteristics of the cohorts, and the statistical risk analyses were performed.

Results: TriNetX identified 13,310 patients for both lumbar puncture patients with antiplatelets and lumbar puncture patients without antiplatelet, anticoagulant, heparin, and LMWH (“blood thinners”) after propensity score matching. For this study, epidural hematoma (OR [95%CI], 1.904 [0.885-4.095]) showed a higher odds ratio compared to subdural hematoma (OR [95%CI], 1.008 [0.784-1.296]), both of which are not statistically significant. A total of 25,788 patients were identified for both lumbar puncture patients with anticoagulants and without blood thinners after propensity score matching. For this study, epidural hematoma (OR [95%CI], 1.000 [0.561-1.784]) also showed a higher odds ratio compared to subdural hematoma (OR [95%CI], 0.780 [0.640-0.950]), of which only subdural hematoma is statistically significant.

Conclusion : The data analyses suggest that there are no increased risks of epidural and subdural hematoma in patients with history of use of antiplatelet or anticoagulant compared to those who do not. These results could be furthered by conducting a retrospective chart review study by involving additional parameters.