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Antithrombotic and Antiplatelet Therapy

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Essentials of Interventional Techniques in Managing Chronic Pain

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Abstract

Managing antithrombotic and antiplatelet therapy is one of the common issues while performing interventional techniques to balance the bleeding risk and perioperative risk of thrombosis. There are myriad procedural guidelines on managing anticoagulant and antithrombotic therapy, even though most are not based on appropriate evidence.

The risks of withholding antiplatelet therapy include cardiovascular, cerebrovascular, and peripheral vascular thrombosis which may result in catastrophic consequences including stroke and death. The risks of continuing antiplatelet therapy include bleeding and fatalities related to bleeding.

Based on an extensive review of the literature, there is good evidence for the risk of a thromboembolic phenomenon in patients who stop antithrombotic therapy. There is also good evidence for the lack of necessity of stopping nonsteroidal anti-inflammatory drugs (NSAIDs), including low-dose aspirin, prior to performing interventional techniques. There is fair evidence that excessive bleeding, including epidural hematoma formation, may occur with interventional techniques when antithrombotic therapy is continued. There is fair evidence that the risk of a thromboembolic phenomenon is higher than the risk of epidural hematomas when antiplatelet therapy is stopped prior to interventional techniques.

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Authors and Affiliations

  1. ASIPP and SIPMS, Paducah, KY, USA

    Laxmaiah Manchikanti

  2. Pain Management Center of Paducah, Paducah, KY, USA

    Laxmaiah Manchikanti

  3. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA

    Laxmaiah Manchikanti

  4. Department of Anesthesia, LSU Health Science Center, New Orleans, LA, USA

    Alan D. Kaye

  5. Mid Atlantic Spine and Pain Physicians, Newark, DE, USA

    Frank J. E. Falco

  6. Pain Medicine Fellowship Program, Temple University Hospital, Philadelphia, PA, USA

    Frank J. E. Falco

  7. Temple University Medical School, Philadelphia, PA, USA

    Frank J. E. Falco

Authors
  1. Laxmaiah Manchikanti
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  2. Alan D. Kaye
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  3. Frank J. E. Falco
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Correspondence to Laxmaiah Manchikanti .

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Editors and Affiliations

  1. Pain Management Center of Paducah, Paducah, Kentucky

    Laxmaiah Manchikanti

  2. Department of Anesthesia, LSU Health Science Center, New Orleans, Louisiana, USA

    Alan D. Kaye

  3. Mid Atlantic Spine and Pain Physicians, Newark, Delaware

    Frank J.E. Falco

  4. Service Line Chief of Interventional Radiology, Director of Interventional Neuroradiology, Chief of NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA

    Joshua A. Hirsch

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Manchikanti, L., Kaye, A.D., Falco, F.J.E. (2018). Antithrombotic and Antiplatelet Therapy. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_6

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