From the Research
Performing a spinal tap in a patient on dual antiplatelet therapy (DAPT) is generally not recommended due to the increased risk of bleeding complications, particularly spinal hematoma. DAPT, which typically includes aspirin plus a P2Y12 inhibitor such as clopidogrel, ticagrelor, or prasugrel, significantly impairs platelet function and increases bleeding risk 1. If a lumbar puncture is absolutely necessary, it's advisable to hold the P2Y12 inhibitor for the appropriate duration before the procedure (5-7 days for clopidogrel, 5 days for ticagrelor, 7 days for prasugrel) while potentially continuing aspirin. Some key points to consider include:
- The risk of bleeding complications, such as spinal hematoma, is increased in patients on DAPT 2, 3
- The decision to perform a lumbar puncture in a patient on DAPT should be individualized based on the urgency of the procedure, the indication for DAPT, and the patient's overall clinical status 4, 5
- In emergency situations where the procedure cannot be delayed, the risk-benefit ratio must be carefully evaluated by the clinical team, with close neurological monitoring after the procedure 1
- Following the spinal tap, DAPT should be resumed according to the patient's cardiovascular risk, typically within 24 hours if no bleeding complications occur 3 It is essential to involve a multidisciplinary discussion between neurology, cardiology, and anesthesiology to minimize potential risks and optimize patient outcomes 2, 5.