Contraindications for Lumbar Puncture
Lumbar puncture has several essential contraindications.
The following are the absolute contraindications:
Van de Beek et al. drafted the ESCMID guidelines for the diagnosis and treatment of bacterial meningitis in 2015,26 and strongly recommended performing imaging of brain before lumbar puncture in patients presenting with:
There is still controversy as to the lowest platelet count at which LP can be done safely to avoid causing spinal or epidural hematoma. As such it constitutes a relative contraindication. Consensus guidelines propose that, a recent platelet count of higher than 40 × 10⁹ cells/L in adults, before an elective spinal tap (based on level 3 evidence),25 is safe.
Patients on antiplatelets and anticoagulants also constitute a relative contraindication. Most of the antithrombotic drugs, except argatroban, have renal clearance and therefore their serum concentrations may be higher in patients with impaired renal function.27
The European Society of Anesthesiology27 has proposed the following intervals of stoppage of antiplatelet and anticoagulant medications {Figure 2} before a spinal tap to mitigate the risk of hemorrhagic complications (e.g., epidural hematoma), considering the patients have normal renal function.
To address this issue further, Lee et al. did a study on 665 patients who were on single or dual antiplatelet and underwent lumbar puncture. They divided these patients into 3 groups depending on the time interval of discontinuation of antiplatelet medication to lumbar puncture viz >4 weeks , 1-4 weeks, <1 week.28 Spinal hematoma occurred in only 0.7% of patients. They also evaluated the risk of traumatic spinal tap. The incidence of traumatic and bloody tap, in those who had stopped taking antiplatelet for 1 week were 4% and 3% respectively, compared to those who had stopped it for more than 4 weeks at 5% for both traumatic and bloody tap. So there was no significant rise in the risk of hemorrhagic complications in patients currently taking aspirin and/or clopidogrel, also regardless of the time interval the antiplatelet drug was stopped prior to the procedure.28