Neuraxial Haematoma in Patients Undergoing Spinal or Epidural Anaesthesia during Uninterrupted Anti-Platelet Therapy: A Systematic Review

Introduction: Neuraxial anaesthesia techniques are a vital technique used in many settings; as intraoperative anaesthesia; for postoperative pain control; in the peripartum period; and in the management of chronic pain conditions. Potential candidates for neuraxial anaesthesia may be receiving anti-platelet agents, which have been linked to increased incidence of neuraxial haematomas. Aim: The purpose of this systematic review was to interrogate the published literature in order to determine the incidence of if neuraxial haematoma in patients undergoing spinal or epidural anaesthesia in the setting of uninterrupted anti-platelets. Methods: A search strategy encompassing the Cochrane database, MEDLINE, and Embase was formulated. The following keywords were used: `Neuroaxial; `Neuro-axial; `Neuraxial; `Spinal; `Epidural; `Haematoma; `Anti-platelet; `Antiplatelet; `Clopidogrel; `Ticagrelor; `Dipyridamole. Results: The initial electronic literature search yielded 203 titles which were assessed for relevance. 495 additional studies were identified from manual scrutiny of reference lists. After removal of duplicates, 466 abstracts were screened in order to ascertain if they were potentially eligible for inclusion. 61 full texts underwent further evaluation and from this 2 studies were included in the systematic review. The Downs and Black score was used to assess the methodological quality of the included studies. Conclusion: Our review indicated that there is a paucity of evidence available regarding the safety of continued anti-platelet therapy in the setting of neuraxial anaesthesia. Further research in the form of randomised controlled trials are warranted in order to provide a definitive answer to this question which is commonplace in clinical practice.