Columbia University College of Physicians and Surgeons, New York, New York.
Vanderbilt University, Nashville, Tennessee.
Pain Med. 2018 Mar 1;19(3):438-448. doi: 10.1093/pm/pnx152.
To determine the risks of continuing or ceasing anticoagulant or antiplatelet medications prior to image-guided procedures for spine pain.
Systematic review of the literature with comprehensive analysis of the published data.
Following a search of the literature for studies pertaining to spine pain interventions in patients on anticoagulant medication, seven reviewers appraised the studies identified and assessed the quality of evidence presented.
Evidence was sought regarding risks associated with either continuing or ceasing anticoagulant and antiplatelet medication in patients having image-guided interventional spine procedures. The evidence was evaluated in accordance with the Grades of Recommendation, Assessment, Development, and Evaluation system.
From a source of 120 potentially relevant articles, 14 provided applicable evidence. Procedures involving interlaminar access carry a nonzero risk of hemorrhagic complications, regardless of whether anticoagulants are ceased or continued. For other procedures, hemorrhagic complications have not been reported, and case series indicate that they are safe when performed in patients who continue anticoagulants. Three articles reported the adverse effects of ceasing anticoagulants, with serious consequences, including death.
Other than for interlaminar procedures, the evidence does not support the view that anticoagulant and antiplatelet medication must be ceased before image-guided spine pain procedures. Meanwhile, the evidence shows that ceasing anticoagulants carries a risk of serious consequences, including death. Guidelines on the use of anticoagulants should reflect these opposing bodies of evidence.
确定在影像引导脊柱疼痛介入治疗前继续或停止抗凝或抗血小板药物的风险。
对文献进行系统回顾，并对已发表数据进行全面分析。
在对接受抗凝药物治疗的脊柱疼痛介入治疗患者相关研究进行文献搜索后，7 位评审员评估了确定的研究，并评估了提出的证据质量。
针对影像引导介入脊柱手术中继续或停止抗凝和抗血小板药物治疗的患者相关风险，寻求证据。根据推荐分级、评估、制定和评估系统对证据进行评估。
从 120 篇潜在相关文章中，有 14 篇提供了适用的证据。无论是否停止抗凝药物，涉及椎板间入路的手术均存在一定的出血性并发症风险。对于其他手术，尚未报告出血性并发症，病例系列表明，对于继续抗凝的患者，手术是安全的。有 3 篇文章报道了停止抗凝药物的不良反应，包括死亡在内的严重后果。
除了椎板间手术外，证据不支持在影像引导脊柱疼痛介入治疗前必须停止抗凝和抗血小板药物的观点。同时，证据表明停止抗凝药物会带来严重后果，包括死亡。抗凝剂使用指南应反映这些相互矛盾的证据。
