title: The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Bleeding and Coagulation Management in Neurostimulation Devices.
abstract: BACKGROUND
  The Neurostimulation Appropriateness Consensus Committee (NACC) was formed by the International Neuromodulation Society (INS) in 2012 to evaluate the evidence to reduce the risk of complications and improve the efficacy of neurostimulation. The first series of papers, published in 2014, focused on the general principles of appropriate practice in the surgical implantation of neurostimulation devices. The NACC was reconvened in 2014 to address specific patient care issues, including bleeding and coagulation.
  
  
  METHODS
  The INS strives to improve patient care in an evidence-based fashion. The NACC members were appointed or recruited by the INS leadership for diverse expertise, including international clinical expertise in many areas of neurostimulation, evidence evaluation, and publication. The group developed best practices based on peer-reviewed evidence and, in the absence of specific evidence, on expert opinion. Recommendations were based on international evidence in accordance with guideline creation.
  
  
  CONCLUSIONS
  The NACC has recommended specific measures to reduce the risk of bleeding and neurological injury secondary to impairment of coagulation in the setting of implantable neurostimulation devices in the spine, brain, and periphery.
authors.affiliation: Center for Pain Relief, Charleston, WV, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Deer
authors.affiliation: Summa Western Reserve Hospital, Cuyahoga Falls, OH, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Narouze
authors.affiliation: Pain Diagnostics and Interventional Care, Sewickley, PA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Provenzano
authors.affiliation: Summit Pain Alliance, Santa Rosa, CA, USA.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Pope
authors.affiliation: St. Luke's University Health Network, Bethlehem, PA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Falowski
authors.affiliation: Hunter Pain Clinic, Broadmeadow, NSW, Australia.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Russo
authors.affiliation: Northwestern Medicine, Chicago, IL, USA.
authors.forename: Honorio
authors.initials: H
authors.lastname: Benzon
authors.affiliation: University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Konstantin
authors.identifier: http://orcid.org/0000-0002-7946-8639
authors.initials: K
authors.lastname: Slavin
authors.affiliation: Neuroscience Institute, Albany, NY, USA.
authors.forename: Julie G
authors.initials: JG
authors.lastname: Pilitsis
authors.affiliation: North American Spine, Houston, TX, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Alo
authors.affiliation: Arizona Pain/Pain Doctor, Midwestern Medical School, Glendale, Arizona, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Carlson
authors.affiliation: Holy Cross Hospital, Fort Lauderdale, Florida, USA.
authors.forename: Porter
authors.initials: P
authors.lastname: McRoberts
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
authors.affiliation: Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Arle
authors.affiliation: Marcus Neuroscience Institute, Boca Raton, FL, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Levy
authors.affiliation: Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Simpson
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
mesh_terms: D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy*; D019468:Disease Management; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D011367:Professional Staff Committees / Q000592:standards*
keywords: Anticoagulation; bleeding; consensus; deep brain stimulation; motor cortex stimulation; neurostimulation; risks; spinal cord stimulation