Bleeding complications in patients undergoing intrathecal drug delivery system implantation

Nafisseh S. Warner, Markus A. Bendel, Matthew Warner, Jacob J. Strand, Halena M. Gazelka, Bryan C. Hoelzer, William D. Mauck, Tim J. Lamer, Daryl J Kor, Susan M. Moeschler

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction. Intrathecal drug delivery systems (IDDSs) have dramatically improved analgesia and the functional status of cancer patients and those with chronic pain states. However, given the close proximity to the neuraxis and frequent concomitant use of antiplatelet or anticoagulant medications, this intervention is not without risk. The goal of this investigation was to determine the incidence of bleeding complications following IDDS placement. Methods. This is a retrospective review from 2005 through 2014 of adult patients undergoing IDDS implantation or revision at a tertiary care center. The primary outcome was a bleeding-related neurological complication requiring emergency medicine, neurology, or neurosurgical evaluation within 31 days. Results. A total of 247 procedures were performed on 216 unique patients. Patients received aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) within seven days of needle placement for 64 procedures (25.9%). A preprocedural platelet count or international normalized ratio (INR) was available within 30 days for 138 procedures (55.9%). Of these, two patients had a platelet count lower than 100 x 109/L and one patient had an INR of 1.5 or higher at the time of the procedure. One neurological complication was identified (0.4%) that was not related to procedural bleeding. Similarly, three patients (1.2%) received a periprocedural red blood cell transfusion, none of which were related to procedural bleeding. Conclusion. No cases of bleeding-related neurological complications were identified following IDDS placement or revision, including in those receiving aspirin or NSAIDs. Future investigations with larger numbers are needed to further explore the safety of antithrombotic therapy continuation or discontinuation periprocedurally.

Original languageEnglish (US)
Pages (from-to)2422-2427
Number of pages6
JournalPain Medicine (United States)
Volume18
Issue number12
DOIs
StatePublished - Dec 1 2017

Fingerprint

Drug Delivery Systems
Hemorrhage
International Normalized Ratio
Platelet Count
Aspirin
Anti-Inflammatory Agents
Erythrocyte Transfusion
Emergency Medicine
Neurology
Tertiary Care Centers
Chronic Pain
Pharmaceutical Preparations
Analgesia
Anticoagulants
Needles
Safety
Incidence
Neoplasms

Keywords

  • Aspirin
  • Bleeding
  • Cancer pain
  • Intrathecal drug delivery system
  • NSAIDs

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Warner, N. S., Bendel, M. A., Warner, M., Strand, J. J., Gazelka, H. M., Hoelzer, B. C., ... Moeschler, S. M. (2017). Bleeding complications in patients undergoing intrathecal drug delivery system implantation. Pain Medicine (United States), 18(12), 2422-2427. https://doi.org/10.1093/pm/pnw363

Bleeding complications in patients undergoing intrathecal drug delivery system implantation. / Warner, Nafisseh S.; Bendel, Markus A.; Warner, Matthew; Strand, Jacob J.; Gazelka, Halena M.; Hoelzer, Bryan C.; Mauck, William D.; Lamer, Tim J.; Kor, Daryl J; Moeschler, Susan M.

In: Pain Medicine (United States), Vol. 18, No. 12, 01.12.2017, p. 2422-2427.

Research output: Contribution to journalArticle

Warner, NS, Bendel, MA, Warner, M, Strand, JJ, Gazelka, HM, Hoelzer, BC, Mauck, WD, Lamer, TJ, Kor, DJ & Moeschler, SM 2017, 'Bleeding complications in patients undergoing intrathecal drug delivery system implantation', Pain Medicine (United States), vol. 18, no. 12, pp. 2422-2427. https://doi.org/10.1093/pm/pnw363
Warner, Nafisseh S. ; Bendel, Markus A. ; Warner, Matthew ; Strand, Jacob J. ; Gazelka, Halena M. ; Hoelzer, Bryan C. ; Mauck, William D. ; Lamer, Tim J. ; Kor, Daryl J ; Moeschler, Susan M. / Bleeding complications in patients undergoing intrathecal drug delivery system implantation. In: Pain Medicine (United States). 2017 ; Vol. 18, No. 12. pp. 2422-2427.
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abstract = "Introduction. Intrathecal drug delivery systems (IDDSs) have dramatically improved analgesia and the functional status of cancer patients and those with chronic pain states. However, given the close proximity to the neuraxis and frequent concomitant use of antiplatelet or anticoagulant medications, this intervention is not without risk. The goal of this investigation was to determine the incidence of bleeding complications following IDDS placement. Methods. This is a retrospective review from 2005 through 2014 of adult patients undergoing IDDS implantation or revision at a tertiary care center. The primary outcome was a bleeding-related neurological complication requiring emergency medicine, neurology, or neurosurgical evaluation within 31 days. Results. A total of 247 procedures were performed on 216 unique patients. Patients received aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) within seven days of needle placement for 64 procedures (25.9{\%}). A preprocedural platelet count or international normalized ratio (INR) was available within 30 days for 138 procedures (55.9{\%}). Of these, two patients had a platelet count lower than 100 x 109/L and one patient had an INR of 1.5 or higher at the time of the procedure. One neurological complication was identified (0.4{\%}) that was not related to procedural bleeding. Similarly, three patients (1.2{\%}) received a periprocedural red blood cell transfusion, none of which were related to procedural bleeding. Conclusion. No cases of bleeding-related neurological complications were identified following IDDS placement or revision, including in those receiving aspirin or NSAIDs. Future investigations with larger numbers are needed to further explore the safety of antithrombotic therapy continuation or discontinuation periprocedurally.",
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T1 - Bleeding complications in patients undergoing intrathecal drug delivery system implantation

AU - Warner, Nafisseh S.

AU - Bendel, Markus A.

AU - Warner, Matthew

AU - Strand, Jacob J.

AU - Gazelka, Halena M.

AU - Hoelzer, Bryan C.

AU - Mauck, William D.

AU - Lamer, Tim J.

AU - Kor, Daryl J

AU - Moeschler, Susan M.

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N2 - Introduction. Intrathecal drug delivery systems (IDDSs) have dramatically improved analgesia and the functional status of cancer patients and those with chronic pain states. However, given the close proximity to the neuraxis and frequent concomitant use of antiplatelet or anticoagulant medications, this intervention is not without risk. The goal of this investigation was to determine the incidence of bleeding complications following IDDS placement. Methods. This is a retrospective review from 2005 through 2014 of adult patients undergoing IDDS implantation or revision at a tertiary care center. The primary outcome was a bleeding-related neurological complication requiring emergency medicine, neurology, or neurosurgical evaluation within 31 days. Results. A total of 247 procedures were performed on 216 unique patients. Patients received aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) within seven days of needle placement for 64 procedures (25.9%). A preprocedural platelet count or international normalized ratio (INR) was available within 30 days for 138 procedures (55.9%). Of these, two patients had a platelet count lower than 100 x 109/L and one patient had an INR of 1.5 or higher at the time of the procedure. One neurological complication was identified (0.4%) that was not related to procedural bleeding. Similarly, three patients (1.2%) received a periprocedural red blood cell transfusion, none of which were related to procedural bleeding. Conclusion. No cases of bleeding-related neurological complications were identified following IDDS placement or revision, including in those receiving aspirin or NSAIDs. Future investigations with larger numbers are needed to further explore the safety of antithrombotic therapy continuation or discontinuation periprocedurally.

AB - Introduction. Intrathecal drug delivery systems (IDDSs) have dramatically improved analgesia and the functional status of cancer patients and those with chronic pain states. However, given the close proximity to the neuraxis and frequent concomitant use of antiplatelet or anticoagulant medications, this intervention is not without risk. The goal of this investigation was to determine the incidence of bleeding complications following IDDS placement. Methods. This is a retrospective review from 2005 through 2014 of adult patients undergoing IDDS implantation or revision at a tertiary care center. The primary outcome was a bleeding-related neurological complication requiring emergency medicine, neurology, or neurosurgical evaluation within 31 days. Results. A total of 247 procedures were performed on 216 unique patients. Patients received aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) within seven days of needle placement for 64 procedures (25.9%). A preprocedural platelet count or international normalized ratio (INR) was available within 30 days for 138 procedures (55.9%). Of these, two patients had a platelet count lower than 100 x 109/L and one patient had an INR of 1.5 or higher at the time of the procedure. One neurological complication was identified (0.4%) that was not related to procedural bleeding. Similarly, three patients (1.2%) received a periprocedural red blood cell transfusion, none of which were related to procedural bleeding. Conclusion. No cases of bleeding-related neurological complications were identified following IDDS placement or revision, including in those receiving aspirin or NSAIDs. Future investigations with larger numbers are needed to further explore the safety of antithrombotic therapy continuation or discontinuation periprocedurally.

KW - Aspirin

KW - Bleeding

KW - Cancer pain

KW - Intrathecal drug delivery system

KW - NSAIDs

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