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Spontaneous Spinal Hematoma in Patients Using Antiplatelets and Anticoagulants: A Systematic Review – Lumbar Spinal Stenosis

This article is a systematic review that examines trends, clinical characteristics, and outcomes associated with Spontaneous Spinal Hematoma (SSH) formation in patients taking antiplatelet (AP) or anticoagulation (AC) medications. The study searched various databases and included ten studies with a total of 259 patients. The results showed that the prevalence of SSH with concomitant ACs treatment was higher compared to APs treatment. The lumbar spine was the most common site of hematoma, and most patients underwent surgical intervention. Immediate diagnosis and intervention were found to be the best prognostic factors for clinical outcomes. The study recommended prompt intervention, high suspicion for patients with neurological deficits, and diagnostic imaging before intervention for determining the treatment plan

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most advanced spine hospital in the world

Published article

CONCLUSIONS: Our review suggested that ACs was related to SSH in most patients (74%), followed by APs (27%) and combined ACs + APs (1.9%). We recommend prompt intervention, a high suspicion for patients with neurological deficits, and diagnostic imaging before intervention to determine a case-specific treatment plan.

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World Neurosurg. 2024 Jan 24:S1878-8750(24)00094-9. doi: 10.1016/j.wneu.2024.01.082. Online ahead of print.ABSTRACTBACKGROUND: Spontaneous Spinal Hematoma (SSH) is a debilitating complication in patients taking either antiplatelet (AP) or anticoagulation (AC) medications. SSH is rare and therefore, a systematic review is warranted to reexamine and outline trends, clinical characteristics, and outcomes associated with SSH formation.METHODS: PubMed, EMBASE, Scopus,

World Neurosurg. 2024 Jan 24:S1878-8750(24)00094-9. doi: 10.1016/j.wneu.2024.01.082. Online ahead of print.

ABSTRACT

BACKGROUND: Spontaneous Spinal Hematoma (SSH) is a debilitating complication in patients taking either antiplatelet (AP) or anticoagulation (AC) medications. SSH is rare and therefore, a systematic review is warranted to reexamine and outline trends, clinical characteristics, and outcomes associated with SSH formation.

METHODS: PubMed, EMBASE, Scopus, and Web-of-Science were searched. Studies reporting clinical data of patients with SSH using ACs were included. In addition, clinical studies meeting our apriori inclusion criteria limited to SSH were further defined in quality through risk bias assessment.

RESULTS: We included ten studies with 259 patients’ pooled data post-screening 3083 abstracts. Within the cohort (n = 259), the prevalence of idiopathic, non-traumatic SSH with concomitant ACs treatment was higher 191 (73.75%) compared to APs treatment (27%). The Lumbar spine was the most common site of hematoma (41.70%), followed by the cervical (22.01%) and thoracic (8.49%) spine. Most patients had surgical intervention (70.27%), and 29.73% had conservative management. The pooled data suggest that immediate diagnosis and intervention are the best prognostic factors in clinical outcomes. Using American Spinal Injury Association (ASIA) grading at initial symptom onset and post-treatment showed the highest efficacy in symptomatic relief (87.64%) and return of motor and sensory symptoms (39.19%).

CONCLUSIONS: Our review suggested that ACs was related to SSH in most patients (74%), followed by APs (27%) and combined ACs + APs (1.9%). We recommend prompt intervention, a high suspicion for patients with neurological deficits, and diagnostic imaging before intervention to determine a case-specific treatment plan.

PMID:38278210 | DOI:10.1016/j.wneu.2024.01.082

The London Spine Unit : most advanced spine hospital in the world

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Spontaneous Spinal Hematoma in Patients Using Antiplatelets and Anticoagulants: A Systematic Review

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World Neurosurg. 2024 Jan 24:S1878-8750(24)00094-9. doi: 10.1016/j.wneu.2024.01.082. Online ahead of print.ABSTRACTBACKGROUND: Spontaneous Spinal Hematoma (SSH) is a debilitating complication in patients taking either antiplatelet (AP) or anticoagulation (AC) medications. SSH is rare and therefore, a systematic review is warranted to reexamine and outline trends, clinical characteristics, and outcomes associated with SSH formation.METHODS: PubMed, EMBASE, Scopus

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