Abstract Number: PB0273
Meeting: ISTH 2020 Congress
Background: Neuraxial anesthesia including spinal, epidural and combined spinal-epidural blocks are anesthetic techniques commonly used for acute pain control in surgery and obstetrics. One of the most feared complications of neuraxial anesthesia is spinal or epidural hematoma which can lead to permanent neurologic injury. The risk of spinal hematoma is generally accepted to be higher in patients with bleeding diatheses compared with the general population, however this conclusion is largely based on anecdotal evidence.
Aims: To describe the hematologic laboratory parameters where neuraxial anesthesia has been administered with and without spinal or epidural hematoma in patients with single pre-existing bleeding disorders/tendencies.
Methods: This scoping review was conducted according to the PRISMA-ScR guidelines. A detailed search strategy was developed in collaboration with a medical librarian and performed in Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science. There were no limits placed on date of publication or study type. Titles and abstracts were screened by two independent reviewers according to the inclusion and exclusion criteria found in Table 1. Reference lists of all publications included in full text review were screened for additional sources. Finally, data were extracted by two reviewers independently using a pre-piloted data extraction form with conflicts resolved by consensus.
Results: The literature search yielded 1362 studies after duplicates were removed. An additional 54 studies were discovered during reference list review and a total of 98 studies were ultimately included in the scoping review. Data analysis is pending with final results expected by April 2020. The final results will be presented at the conference.
Conclusions: Our findings are expected to highlight the paucity of data in the existing literature surrounding the safe use of neuraxial anesthesia in patients with single pre-existing bleeding disorders/tendencies. This represents an important knowledge gap that requires expert consensus-based recommendations and additional research to help guide clinical care.
|Patients with current diagnosis of a single bleeding disorder known prior to administration of neuraxial anesthetic including: von Willebrand disease, immune thrombocytopenia, gestational thrombocytopenia, thrombocytopenia associated with hypertensive disorders of pregnancy, platelet function disorders, factor VII deficiency, hemophilia A and B including carriers, factor XI deficiency, factor XIII deficiency and fibrinogen disorders
|Presence of a secondary bleeding disorder or co-morbidity that predisposes to bleeding (eg. liver or renal dysfunction, spinal cord arteriovenous malformation)
|Patient received neuraxial anesthetic
|Peripheral nerve blocks, lumbar puncture
|Spinal or epidural hematoma, if present, was confirmed with imaging
|Article in a language other than English
[Table 1: Scoping review inclusion and exclusion criteria]
To cite this abstract in AMA style:Peterson W, Tse B, Martin R, Fralick M, Sholzberg M. Hematologic Laboratory Parameters and Hemostatic Thresholds for the Safe Administration of Neuraxial Anesthesia in Adults with Pre-Existing Bleeding Disorders: A Scoping Review [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/hematologic-laboratory-parameters-and-hemostatic-thresholds-for-the-safe-administration-of-neuraxial-anesthesia-in-adults-with-pre-existing-bleeding-disorders-a-scoping-review/. Accessed February 20, 2024.
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