Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients a report from the multicenter perioperative outcomes group

Linden O. Lee, Brian T. Bateman, Sachin Kheterpal, Thomas T. Klumpner, Michelle Housey, Michael Aziz, Karen W. Hand, Mark MacEachern, Christopher G. Goodier, Jeffrey Bernstein, Melissa E. Bauer

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Trombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. Tere is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. Te authors reviewed a large perioperative database and performed a systematic review to further defne the risk of epidural hematoma requiring surgical decompression in this population. Methods: Te authors performed a retrospective cohort study using the Multicenter Perioperative Outcomes Group database to identify thrombocytopenic parturients who received a neuraxial technique and to estimate the risk of epidural hematoma. Patients were stratifed by platelet count, and those requiring surgical decompression were identifed. A systematic review was performed, and risk estimates were combined with those from the existing literature. Results: A total of 573 parturients with a platelet count less than 100,000mm-3 who received a neuraxial technique across 14 institutions were identifed in the Multicenter Perioperative Outcomes Group database, and a total of 1,524 parturients were identifed after combining the data from the systematic review. No cases of epidural hematoma requiring surgical decompression were observed. Te upper bound of the 95% CI for the risk of epidural hematoma for a platelet count of 0 to 49,000 mm-3 is 11%, for 50,000 to 69,000mm-3 is 3%, and for 70,000 to 100,000mm-3 is 0.2%. Conclusions: Te number of thrombocytopenic parturients in the literature who received neuraxial techniques without complication has been signifcantly increased. Te risk of epidural hematoma associated with neuraxial techniques in parturients at a platelet count less than 70,000mm-3 remains poorly defned due to limited observations.

Original languageEnglish (US)
Pages (from-to)1053-1064
Number of pages12
JournalAnesthesiology
Volume126
Issue number6
DOIs
StatePublished - 2017

Fingerprint

Hematoma
Parturition
Platelet Count
Surgical Decompression
Databases
Cohort Studies
Retrospective Studies
Population

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients a report from the multicenter perioperative outcomes group. / Lee, Linden O.; Bateman, Brian T.; Kheterpal, Sachin; Klumpner, Thomas T.; Housey, Michelle; Aziz, Michael; Hand, Karen W.; MacEachern, Mark; Goodier, Christopher G.; Bernstein, Jeffrey; Bauer, Melissa E.

In: Anesthesiology, Vol. 126, No. 6, 2017, p. 1053-1064.

Research output: Contribution to journalArticle

Lee, LO, Bateman, BT, Kheterpal, S, Klumpner, TT, Housey, M, Aziz, M, Hand, KW, MacEachern, M, Goodier, CG, Bernstein, J & Bauer, ME 2017, 'Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients a report from the multicenter perioperative outcomes group', Anesthesiology, vol. 126, no. 6, pp. 1053-1064. https://doi.org/10.1097/ALN.0000000000001630
Lee, Linden O. ; Bateman, Brian T. ; Kheterpal, Sachin ; Klumpner, Thomas T. ; Housey, Michelle ; Aziz, Michael ; Hand, Karen W. ; MacEachern, Mark ; Goodier, Christopher G. ; Bernstein, Jeffrey ; Bauer, Melissa E. / Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients a report from the multicenter perioperative outcomes group. In: Anesthesiology. 2017 ; Vol. 126, No. 6. pp. 1053-1064.
@article{9fe6860a63ef43339449c5667eece8d5,
title = "Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients a report from the multicenter perioperative outcomes group",
abstract = "Background: Trombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. Tere is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. Te authors reviewed a large perioperative database and performed a systematic review to further defne the risk of epidural hematoma requiring surgical decompression in this population. Methods: Te authors performed a retrospective cohort study using the Multicenter Perioperative Outcomes Group database to identify thrombocytopenic parturients who received a neuraxial technique and to estimate the risk of epidural hematoma. Patients were stratifed by platelet count, and those requiring surgical decompression were identifed. A systematic review was performed, and risk estimates were combined with those from the existing literature. Results: A total of 573 parturients with a platelet count less than 100,000mm-3 who received a neuraxial technique across 14 institutions were identifed in the Multicenter Perioperative Outcomes Group database, and a total of 1,524 parturients were identifed after combining the data from the systematic review. No cases of epidural hematoma requiring surgical decompression were observed. Te upper bound of the 95{\%} CI for the risk of epidural hematoma for a platelet count of 0 to 49,000 mm-3 is 11{\%}, for 50,000 to 69,000mm-3 is 3{\%}, and for 70,000 to 100,000mm-3 is 0.2{\%}. Conclusions: Te number of thrombocytopenic parturients in the literature who received neuraxial techniques without complication has been signifcantly increased. Te risk of epidural hematoma associated with neuraxial techniques in parturients at a platelet count less than 70,000mm-3 remains poorly defned due to limited observations.",
author = "Lee, {Linden O.} and Bateman, {Brian T.} and Sachin Kheterpal and Klumpner, {Thomas T.} and Michelle Housey and Michael Aziz and Hand, {Karen W.} and Mark MacEachern and Goodier, {Christopher G.} and Jeffrey Bernstein and Bauer, {Melissa E.}",
year = "2017",
doi = "10.1097/ALN.0000000000001630",
language = "English (US)",
volume = "126",
pages = "1053--1064",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients a report from the multicenter perioperative outcomes group

AU - Lee, Linden O.

AU - Bateman, Brian T.

AU - Kheterpal, Sachin

AU - Klumpner, Thomas T.

AU - Housey, Michelle

AU - Aziz, Michael

AU - Hand, Karen W.

AU - MacEachern, Mark

AU - Goodier, Christopher G.

AU - Bernstein, Jeffrey

AU - Bauer, Melissa E.

PY - 2017

Y1 - 2017

N2 - Background: Trombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. Tere is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. Te authors reviewed a large perioperative database and performed a systematic review to further defne the risk of epidural hematoma requiring surgical decompression in this population. Methods: Te authors performed a retrospective cohort study using the Multicenter Perioperative Outcomes Group database to identify thrombocytopenic parturients who received a neuraxial technique and to estimate the risk of epidural hematoma. Patients were stratifed by platelet count, and those requiring surgical decompression were identifed. A systematic review was performed, and risk estimates were combined with those from the existing literature. Results: A total of 573 parturients with a platelet count less than 100,000mm-3 who received a neuraxial technique across 14 institutions were identifed in the Multicenter Perioperative Outcomes Group database, and a total of 1,524 parturients were identifed after combining the data from the systematic review. No cases of epidural hematoma requiring surgical decompression were observed. Te upper bound of the 95% CI for the risk of epidural hematoma for a platelet count of 0 to 49,000 mm-3 is 11%, for 50,000 to 69,000mm-3 is 3%, and for 70,000 to 100,000mm-3 is 0.2%. Conclusions: Te number of thrombocytopenic parturients in the literature who received neuraxial techniques without complication has been signifcantly increased. Te risk of epidural hematoma associated with neuraxial techniques in parturients at a platelet count less than 70,000mm-3 remains poorly defned due to limited observations.

AB - Background: Trombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. Tere is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. Te authors reviewed a large perioperative database and performed a systematic review to further defne the risk of epidural hematoma requiring surgical decompression in this population. Methods: Te authors performed a retrospective cohort study using the Multicenter Perioperative Outcomes Group database to identify thrombocytopenic parturients who received a neuraxial technique and to estimate the risk of epidural hematoma. Patients were stratifed by platelet count, and those requiring surgical decompression were identifed. A systematic review was performed, and risk estimates were combined with those from the existing literature. Results: A total of 573 parturients with a platelet count less than 100,000mm-3 who received a neuraxial technique across 14 institutions were identifed in the Multicenter Perioperative Outcomes Group database, and a total of 1,524 parturients were identifed after combining the data from the systematic review. No cases of epidural hematoma requiring surgical decompression were observed. Te upper bound of the 95% CI for the risk of epidural hematoma for a platelet count of 0 to 49,000 mm-3 is 11%, for 50,000 to 69,000mm-3 is 3%, and for 70,000 to 100,000mm-3 is 0.2%. Conclusions: Te number of thrombocytopenic parturients in the literature who received neuraxial techniques without complication has been signifcantly increased. Te risk of epidural hematoma associated with neuraxial techniques in parturients at a platelet count less than 70,000mm-3 remains poorly defned due to limited observations.

UR - http://www.scopus.com/inward/record.url?scp=85017127407&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017127407&partnerID=8YFLogxK

U2 - 10.1097/ALN.0000000000001630

DO - 10.1097/ALN.0000000000001630

M3 - Article

C2 - 28383323

AN - SCOPUS:85017127407

VL - 126

SP - 1053

EP - 1064

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 6

ER -