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8 Articles in this Series
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Bleeding Complications Rare in Interventional Pain Procedures
Spinal Cord Compression Following Spinal Cord Stimulation: A Case Report

Bleeding Complications Rare in Interventional Pain Procedures

Patients do not need to stop their aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) before minimally invasive pain procedures. The rate of bleeding complications following interventional pain procedures is low, including the need for blood transfusion and bleeding-related neurological complications, according to a new study from the Mayo Clinic.1

These findings lend support to the safety of interventional pain procedures, even in the presence of aspirin or NSAIDs.

In the surgical arena, aspirin and NSAID therapy are often feared for their negative influence on platelet activation and clot formation. “However, little is known regarding the safety of aspirin and NSAID therapy prior to invasive pain procedures,” lead author Nafisseh Warner, MD, said.  “This is a first step to better understand these relationships.”

To answer the question of how often bleeding complications occur, the investigators retrospectively analyzed data for 24,615 adult patients undergoing 58,093 pain procedures from 2005 through 2014. Preoperative aspirin or NSAID therapy was present within 7 days for 17,833 procedures (30.7%). The study reports on moderate-risk procedures, including epidural steroid injections, facet injections, medial branch blocks and radiofrequency ablations, sympathetic blocks and peripheral nerve blocks, among others. 

Researchers found that significant bleeding complications—defined as requirements for red blood cell (RBC) transfusion within 72 hours—occurred in less than 1 in 1,000 procedures. The rate of RBC transfusion for patients receiving aspirin or NSAIDs was 0.08% compared to a transfusion rate of 0.07% in those not on aspirin or NSAIDs (P = 0.619). Furthermore, 5 (0.009%) neurologic complications were identified; only 2 bleeding complications resulted in a clinically significant neurological complication.

The findings support recently published guidelines regarding antiplatelet and anticoagulant medication use in patients undergoing interventional pain and spine procedures.2

“Our data suggest that the continuation of aspirin and NSAID therapy through the peri-procedural encounter for low- and intermediate-risk pain procedures is likely safe,” said Dr. Warner, an anesthesia resident and pain fellow at the Mayo Clinic in Rochester Minn. “It is important for providers to recognize that there may be significant risk in discontinuing aspirin therapy in patients receiving this therapy for secondary prevention.”

The team is currently exploring bleeding complications in high-risk procedures, including spinal cord stimulator trials and implantations, and intrathecal drug delivery system placements, and expects to report those results separately.

In addition, Dr. Warner explained, “Before any significant practice changes are made, we will be seeking to expand our data with the experiences of other institutions, hence obtaining a large multicenter cohort of patients representing a diverse array of pain procedures.”


1.      Warner N, Hooten W, Warner M, et al. Bleeding Complications in Patients Undergoing Interventional Pain Procedures: A Retrospective Review. Poster presentation at: 32nd Annual Meeting of the American Academy of Pain Medicine; February 18-21, 2016; Palm Springs, CA. Poster #159.

2.       Narouze S, Benzon HT, Provenzano DA, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2015;40(3):182-212.

Next summary: Spinal Cord Compression Following Spinal Cord Stimulation: A Case Report
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