From the Research
Lumbar puncture can be safely performed in patients taking clopidogrel without discontinuing the medication, as the risk of spinal hematoma is low, according to the most recent and highest quality study 1. The study published in the Journal of Neurology in 2023 found that the incidence of traumatic tap among patients who underwent lumbar puncture under ADP receptor antagonists, including clopidogrel, was 5%, which is not significantly different from the incidence in patients who underwent lumbar puncture without any anti-platelet agents 1. Key points to consider when performing a lumbar puncture in a patient taking clopidogrel include:
- The use of the smallest gauge needle possible to minimize bleeding risk
- Having an experienced operator perform the procedure
- Close neurological monitoring for 24-48 hours post-procedure to detect early signs of spinal hematoma
- Weighing the risks and benefits of discontinuing clopidogrel against the potential risks of delaying the procedure, particularly in patients with high-risk conditions such as recent coronary stent placement. Other studies have also investigated the risk of bleeding associated with lumbar puncture in patients taking antiplatelet agents, including clopidogrel 2, 3, 4, but the most recent and highest quality study 1 suggests that discontinuing clopidogrel may not be necessary. Additionally, the use of ultrasound-guided lumbar puncture may also be considered, as it has been shown to be safe and effective in pediatric patients 5, although its use in adult patients taking clopidogrel has not been specifically studied.