Bleeding Complications in Patients Undergoing Intrathecal Drug Delivery System Implantation.
BACKGROUND
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.


CONCLUSIONS
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.
Departments of Anesthesiology.|Pain Medicine.
Nafisseh S
NS
Warner
Departments of Anesthesiology.|Pain Medicine.
Markus A
MA
Bendel
Departments of Anesthesiology.|Critical Care Medicine.
Matthew A
MA
Warner
Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Jacob J
JJ
Strand
Departments of Anesthesiology.|Pain Medicine.|Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Halena M
HM
Gazelka
Departments of Anesthesiology.|Pain Medicine.
Bryan C
BC
Hoelzer
Departments of Anesthesiology.|Pain Medicine.
William D
WD
Mauck
Departments of Anesthesiology.|Pain Medicine.
Tim J
TJ
Lamer
Departments of Anesthesiology.|Critical Care Medicine.
Daryl J
DJ
Kor
Departments of Anesthesiology.|Pain Medicine.
Susan M
SM
Moeschler
D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000188:drug therapy; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D015918:Infusion Pumps, Implantable; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D059408:Pain Management / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies
Cancer pain; NSAIDs; aspirin; bleeding; intrathecal drug delivery system