The risks of continuing or discontinuing anticoagulants for patients undergoing common interventional pain procedures

Abstract

BACKGROUND.: Guidelines have been published that recommend discontinuing anticoagulants in patients undergoing interventional pain procedures. The safety and effectiveness of these guidelines have not been tested. OBJECTIVES.: The present study was performed to determine if continuing or discontinuing anticoagulants for pain procedures is associated with a detectable risk of complications. METHODS.: An observational study was conducted in a private practice in which some partners continued anticoagulants while other partners routinely discontinued anticoagulants. RESULTS.: No complications attributable to anticoagulants were encountered in 4,766 procedures in which anticoagulants were continued. In 2,296 procedures in which anticoagulants were discontinued according to the guidelines, nine patients suffered serious morbidity, including two deaths. CONCLUSIONS.: Lumbar transforaminal injections, lumbar medial branch blocks, trigger point injections, and sacroiliac joint blocks appear to be safe in patients who continue anticoagulants. In patients who discontinue anticoagulants, although low (0.2%) the risk of serious complications is not zero, and must be considered when deciding between continuing and discontinuing anticoagulants.