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 F. Aziz; Karen W. Hand; Mark MacEachern; Christopher G. Goodier; Jeffrey Bernstein; Melissa E. Bauer; Philip Lirk; Janet Wilczak; Roy Soto; Simon Tom; Germaine Cuff; Daniel A. Biggs; Traci Coffman; Leif Saager; Warren J. Levy; Michael Godbold; Nathan L. Pace; Kevin L. Wethington; William C. Paganelli; Marcel E. Durieux; Karen B. Domino; Bala Nair; Jesse M. Ehrenfeld; Jonathan P. Wanderer; Robert B. Schonberger; Joshua Berris; Steven Lins; Peter Coles; Kenneth C. Cummings; Kamal Maheshwari; Mitchell F. Berman; Christopher Wedeven; John LaGorio; Peter M. Fleishut; Terri A. Ellis; Susan Molina; Curtis Carl; Bassam Kadry; Wilton A A van Klei; Wietze Pasma; Leslie C. Jameson; Daniel L. Helsten; Michael S. Avidan

doi:10.1097/ALN.0000000000001630

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 F. Aziz, Karen W. Hand, Mark MacEachern, Christopher G. Goodier, Jeffrey Bernstein, Melissa E. Bauer, Philip Lirk, Janet Wilczak, Roy Soto, Simon Tom, Germaine Cuff, Daniel A. Biggs, Traci Coffman, Leif Saager, Warren J. LevyMichael Godbold, Nathan L. Pace, Kevin L. Wethington, William C. Paganelli, Marcel E. Durieux, Karen B. Domino, Bala Nair, Jesse M. Ehrenfeld, Jonathan P. Wanderer, Robert B. Schonberger, Joshua Berris, Steven Lins, Peter Coles, Kenneth C. Cummings, Kamal Maheshwari, Mitchell F. Berman, Christopher Wedeven, John LaGorio, Peter M. Fleishut, Terri A. Ellis, Susan Molina, Curtis Carl, Bassam Kadry, Wilton A A van Klei, Wietze Pasma, Leslie C. Jameson, Daniel L. Helsten, Michael S. Avidan

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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 language	English
Pages (from-to)	1053-1064
Number of pages	12
Journal	Anesthesiology
Volume	126
Issue number	6
DOIs	https://doi.org/10.1097/ALN.0000000000001630
Publication status	Published - Jun 2017

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Lee, L. O., Bateman, B. T., Kheterpal, S., Klumpner, T. T., Housey, M., Aziz, M. F., Hand, K. W., MacEachern, M., Goodier, C. G., Bernstein, J., Bauer, M. E., Lirk, P., Wilczak, J., Soto, R., Tom, S., Cuff, G., Biggs, D. A., Coffman, T., Saager, L., ... Avidan, M. S. (2017). Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients: A Report from the Multicenter Perioperative Outcomes Group. Anesthesiology, 126(6), 1053-1064. https://doi.org/10.1097/ALN.0000000000001630

@article{90455f0572bd4c959aeb219cfb179e00,

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 Aziz, {Michael F.} and Hand, {Karen W.} and Mark MacEachern and Goodier, {Christopher G.} and Jeffrey Bernstein and Bauer, {Melissa E.} and Philip Lirk and Janet Wilczak and Roy Soto and Simon Tom and Germaine Cuff and Biggs, {Daniel A.} and Traci Coffman and Leif Saager and Levy, {Warren J.} and Michael Godbold and Pace, {Nathan L.} and Wethington, {Kevin L.} and Paganelli, {William C.} and Durieux, {Marcel E.} and Domino, {Karen B.} and Bala Nair and Ehrenfeld, {Jesse M.} and Wanderer, {Jonathan P.} and Schonberger, {Robert B.} and Joshua Berris and Steven Lins and Peter Coles and Cummings, {Kenneth C.} and Kamal Maheshwari and Berman, {Mitchell F.} and Christopher Wedeven and John LaGorio and Fleishut, {Peter M.} and Ellis, {Terri A.} and Susan Molina and Curtis Carl and Bassam Kadry and {van Klei}, {Wilton A A} and Wietze Pasma and Jameson, {Leslie C.} and Helsten, {Daniel L.} and Avidan, {Michael S.}",

year = "2017",

month = jun,

doi = "10.1097/ALN.0000000000001630",

language = "English",

volume = "126",

pages = "1053--1064",

journal = "Anesthesiology",

issn = "0003-3022",

publisher = "Lippincott Williams & Wilkins",

number = "6",

}

Lee, LO, Bateman, BT, Kheterpal, S, Klumpner, TT, Housey, M, Aziz, MF, Hand, KW, MacEachern, M, Goodier, CG, Bernstein, J, Bauer, ME, Lirk, P, Wilczak, J, Soto, R, Tom, S, Cuff, G, Biggs, DA, Coffman, T, Saager, L, Levy, WJ, Godbold, M, Pace, NL, Wethington, KL, Paganelli, WC, Durieux, ME, Domino, KB, Nair, B, Ehrenfeld, JM, Wanderer, JP, Schonberger, RB, Berris, J, Lins, S, Coles, P, Cummings, KC, Maheshwari, K, Berman, MF, Wedeven, C, LaGorio, J, Fleishut, PM, Ellis, TA, Molina, S, Carl, C, Kadry, B, van Klei, WAA, Pasma, W, Jameson, LC, Helsten, DL & Avidan, MS 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

TY - JOUR

T1 - Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients

T2 - 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 F.

AU - Hand, Karen W.

AU - MacEachern, Mark

AU - Goodier, Christopher G.

AU - Bernstein, Jeffrey

AU - Bauer, Melissa E.

AU - Lirk, Philip

AU - Wilczak, Janet

AU - Soto, Roy

AU - Tom, Simon

AU - Cuff, Germaine

AU - Biggs, Daniel A.

AU - Coffman, Traci

AU - Saager, Leif

AU - Levy, Warren J.

AU - Godbold, Michael

AU - Pace, Nathan L.

AU - Wethington, Kevin L.

AU - Paganelli, William C.

AU - Durieux, Marcel E.

AU - Domino, Karen B.

AU - Nair, Bala

AU - Ehrenfeld, Jesse M.

AU - Wanderer, Jonathan P.

AU - Schonberger, Robert B.

AU - Berris, Joshua

AU - Lins, Steven

AU - Coles, Peter

AU - Cummings, Kenneth C.

AU - Maheshwari, Kamal

AU - Berman, Mitchell F.

AU - Wedeven, Christopher

AU - LaGorio, John

AU - Fleishut, Peter M.

AU - Ellis, Terri A.

AU - Molina, Susan

AU - Carl, Curtis

AU - Kadry, Bassam

AU - van Klei, Wilton A A

AU - Pasma, Wietze

AU - Jameson, Leslie C.

AU - Helsten, Daniel L.

AU - Avidan, Michael S.

PY - 2017/6

Y1 - 2017/6

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

U2 - 10.1097/ALN.0000000000001630

DO - 10.1097/ALN.0000000000001630

M3 - Article

C2 - 28383323

AN - SCOPUS:85017127407

SN - 0003-3022

VL - 126

SP - 1053

EP - 1064

JO - Anesthesiology

JF - Anesthesiology

IS - 6

ER -

Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients: A Report from the Multicenter Perioperative Outcomes Group

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