Conclusion The increased vigilance over venous thromboembolism and introduction of more efficacious antiplatelet agents has introduced a degree of complexity into the performance of spinal procedures.
Suspected increased intracranial pressure ICP is a relative contraindication to performance of an LP and also requires independent assessment and treatment. While thromboelastography was of no help in assessing the degree of anticoagulation, the effects of platelet transfusion were reflected by adenosine diphosphate and epinephrine aggregometry.
Clinically important drug interactions with anticoagulants: Risk for patients taking antiplatelet agents: However, we believe a face mask can reasonably be used for diagnostic procedures especially if the procedure is likely to be prolonged or difficult, or if the person carrying out the procedure has an upper respiratory tract infection.
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Specific treatments are discussed separately. Circulation ; To date there has been limited discussion in the Emergency Medicine literature evaluating the potential risk of performing a LP in a patient who is anticoagulated. The portfolio may include medical or drug companies.
Furthermore, she had coronary artery disease with angina at moderate physical activity, which had been treated by angioplasty and stent implantation. Unfortunately for ED providers, these guidelines suggest the need for caution without fully appreciating the emergent nature and technical nuances of LP performed in the ED. Precautions for preventing transmission of infection Initial therapy and prognosis of bacterial meningitis in adults Patient education: Ultrasound imaging for lumbar punctures and epidural catheterisations: Neurol Clin ; Correct patient positioning is an important determinant of success in obtaining CSF.
Continued surveillance of the literature will be necessary to stay abreast of the newer agents that are sure to appear, as well as any changes in the recommendations regarding agents currently in use.
Drag here to resize the topic outline. The data regarding the risk posed by clopidogrel is limited to an isolated case report of a patient who developed a post-procedural epidural hematoma while taking clopidogrel, diclofenac, and aspirin.
When the LP is delayed or deferred in the setting of suspected bacterial meningitis, it is important to obtain blood cultures which reveal the pathogen in more than half of patients and promptly institute antibiotic therapy.
Patients with mild symptoms or early signs of recovery may be managed conservatively with vigilant monitoring; dexamethasone may be administered to mitigate against neurologic injury [ 46,47 ]. Risk for patients taking systemic anticoagulants: Because meningitis can be caused in animals by performing an LP after first inducing a bacteremia [ 37,38 ], several authors have speculated that an LP in a bacteremic patient without preexisting meningitis might actually cause meningitis [ 39 ].
With the other agents, coags may be completely normal, but patient would still be at risk for bleeding complications.