NOACs can be restarted six to eight hours after an atraumatic spinal or epidural anesthesia or clean LP; however, in traumatic procedures with increased risk of bleeding, the guidelines recommend restarting NOACs
48 to 72 hours after complete hemostasis
[56].
When do you start heparin after lumbar puncture?
A prospective study evaluating the heparin associated bleeding risk after LP showed a higher risk of major bleeding complications if heparin is given
less than 1 hour after LP30,31
; therefore, heparin may be restarted after 1 hour after LP.
When should I restart anticoagulation after surgery?
We generally restart apixaban
one day after low/moderate bleeding risk surgery
and two days after a high bleeding risk surgery.
Is anticoagulation a contraindication to lumbar puncture?
Lumbar Puncture is
relatively contraindicated
in patients with INR > 1.4 due to concern for iatrogenic spinal hematoma leading to possibly irreversible neurologic injury. Therefore, all patients who are therapeutically anticoagulated with Warfarin (INR >2.0) are at increased risk.
Which of the following procedure is contraindicated after lumbar puncture?
Knowledge of anatomical landmarks and proper sterile technique are important when performing a lumbar puncture (LP). Absolute contraindications to LP are
skin infection over puncture site and a brain mass causing increased intracranial pressure
.
When can you restart aspirin after lumbar puncture?
The DOACs can be restarted
6 hours after LP
. can be reversed; this should be discussed with the local haematology team. Aspirin has not been shown to increase the risk of serious bleeding following minor procedures such as LP and so can be continued safely.
What are the complications of lumbar puncture?
- Post-lumbar puncture headache. Around 25% of people who have undergone a lumbar puncture develop a headache afterward due to a leak of fluid into nearby tissues. …
- Back discomfort or pain. You may feel pain or tenderness in your lower back after the procedure. …
- Bleeding. …
- Brainstem herniation.
When can I restart DOAC after surgery?
Following major surgery, or procedure with high bleeding risk, DOACs should not be re-introduced at full dose until
at least 48 hours post procedure
.
How long after surgery can you restart aspirin?
| Surgical bleeding risk level Cardiac risk level | Low risk* Intermediate risk† | High risk¶ Stop aspirin or clopidogrel if necessary (five days before surgery) Vital surgery: okay | Maintain aspirin | Restart within 24 hours after surgery Stop clopidogrel five days before surgery, if prescribed; restart within 24 hours after surgery |
|---|
When do you stop heparin infusion immediately?
Discontinue heparin infusion
4 – 6 hours prior to surgery
or sooner per discretion by surgeon or anti-Xa level < 0.2 unit/mL. b. Re-order heparin 12 – 24 hours after surgery when hemostasis is achieved and there is no evidence of bleeding in consultation with surgeon.
What level should a lumbar puncture be?
Therefore a lumbar puncture is generally performed at
or below the L3-L4 interspace
. As a general anatomical rule, the line drawn between the posterior iliac crests often corresponds closely to the level of L3-L4. The interspace is selected after palpation of the spinous processes at each lumbar level.
What diseases can be found in spinal fluid?
- meningitis.
- encephalitis.
- tuberculosis.
- fungal infections.
- West Nile virus.
- eastern equine encephalitis virus (EEEV)
When should you not do LP?
We recommend not performing an LP in patients with coagulation defects who are actively bleeding, have
severe thrombocytopenia
(eg, platelet counts <50,000 to 80,000/microL), or have an international normalized ratio (INR) >1.4, without correcting the underlying abnormalities.
Which position is most likely indicated after the lumbar puncture procedure?
Patients are advised to lay flat for 30-60mins post procedure. They may require an additional 2 weeks depending on symptoms after this of strict
bed
rest. At times anaesthetic management using an epidural blood patch may be required for severe intractable cases.
What happens if too much CSF is drained?
It is possible that the
puncture of the ventricle
or the opening of the dura will result in an intracranial hemorrhage. It is possible that if too much CSF is removed from the ventricles, either during a drainage procedure or when the ventricle is first punctured, the ventricle may collapse and occlude the catheter.
How much CSF is removed in a lumbar puncture?
A large volume lumbar puncture is a special kind of lumbar puncture (spinal tap) specifically intended to remove
30 to 40 ml
of cerebrospinal fluid (CSF) to both assess and temporarily relieve symptoms of hydrocephalus.
