Stichaller Laura, Krajnc Nik, Leutmezer Fritz, Stögmann Elisabeth, Zimprich Friedrich, Zrzavy Tobias, Berger Thomas, Bsteh Gabriel
Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
J Neurol. 2024 Dec 24;272(1):88. doi: 10.1007/s00415-024-12864-6.
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/m [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.
腰椎穿刺（LP）是评估神经系统疾病的一项关键诊断程序。尽管被认为是安全的，但仍可能发生诸如腰穿后头痛（PDPH）、背痛、硬膜下血肿或静脉窦血栓形成等并发症。抗血小板治疗（APT）的使用是否会增加腰穿后并发症的风险仍不清楚。
这项回顾性观察性研究纳入了783例行诊断性腰穿的患者。我们采用多因素逻辑回归模型，以并发症为因变量，APT为自变量，并对潜在混杂因素进行校正。
纳入的783例患者中（54.0%为女性，中位年龄48岁[四分位间距33 - 64]，中位体重指数24.7kg/m²[四分位间距21.8 - 28.3]，111例[14.2%]接受APT），182例（23.2%）患者出现并发症。最常见的并发症分别为152例（19.4%）患者发生PDPH和42例（5.4%）患者出现背痛。1例（0.1%）患者发生静脉窦血栓形成。在多因素逻辑回归模型中，年龄较小（每10岁比值比1.49，95%置信区间1.32 - 1.69，p < 0.001）和女性（比值比1.74，95%置信区间1.19 - 2.54，p = 0.005）与并发症发生的可能性较高相关，而APT（比值比0.63，95%置信区间0.30 - 1.36，p = 0.241）和最终诊断则无此关联。
腰穿后约四分之一的患者会出现并发症，年龄较小和女性是显著的危险因素。由于APT与并发症风险增加无关，因此可能无需对接受APT治疗的患者停用腰穿检查。
