///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Neuraxial Techniques in Thrombocytopenic Patients Across Populations: A Systematic Review and Meta-analysis

Abstract Number: T2I-284
Abstract Type: Original Research

Melissa E Bauer D.O.1 ; Roulhac D Toledano MD, PhD2; Tim Houle PhD3; Mark MacEachern MLIS4; Lisa Leffert MD5

Background: There is currently no consensus regarding the threshold platelet count to ensure safe neuraxial techniques. There are numerous reports of the safe performance of lumbar punctures (LPs) in severely thrombocytopenic patients, but reports of neuraxial blockade in thrombocytopenic parturients are limited. (1) Given the rarity of spinal epidural hematoma (SEH), more data are needed to inform clinical practice. This systematic review consolidates all reported lumbar neuraxial procedures from multiple diverse thrombocytopenic populations to further elucidate the risk.

Methods: MEDLINE, Embase, Cochrane, CINAHL databases were searched for articles about thrombocytopenic patients (less than 100 x 10^9/L) who received a lumbar neuraxial technique and subsequently did or did not develop SEH. Articles were excluded if the patient also received anticoagulation or if the platelet count/range was not reported. Platelet count, thrombocytopenia etiology, neuraxial procedure type, and patient population (e.g. obstetric, cancer, pediatric) were collected. To evaluate the expected distribution, generalized additive models with interval censoring were used. This approach allowed flexible curves to fit the distribution and can properly weight the available evidence that is reported using coarsened data (i.e., reported using frequency bins).

Results: Of 4167 articles reviewed, 132 met inclusion criteria. 7790 lumbar neuraxial procedures were performed without SEH formation, mostly LPs in pediatric cancer patients [4781(61%)]. 32 cases of SEH were reported, most in cancer patients [13(41%)] after LPs [24(75%)] with platelet counts less than 50,000 [19(59%)]. The 4 reported obstetric SEHs occurred at platelet counts of 58,000, 66,000, 71,000, and 91,000. (2-5) A density plot of neuraxial techniques performed with events of SEH is shown in Figure 1.

Discussion: Reported cases of SEH in thrombocytopenic patients after lumbar neuraxial procedures are exceedingly rare. Although the incidence of thrombocytopenia in pregnancy is 7-12%, (6) there are very few reported cases of SEH with neuraxial procedures. This systematic review and a subsequent modified delphi process will form the basis of the forthcoming SOAP interdisciplinary consensus statement on neuraxial techniques for thrombocytopenic parturients.

1) Lee, Anesthesiology 2017

2) Nguyen, Can J Anaesth 2006

3) Abut, A&A 2006

4) Yuen, Anaesthesia 1999

5) Koyama, IJOA 2009

6) ACOG Practice Bulletin 166, 2018

SOAP 2019