PMID- 38278210 OWN - NLM STAT- MEDLINE DCOM- 20240410 LR - 20240410 IS - 1878-8769 (Electronic) IS - 1878-8750 (Linking) VI - 184 DP - 2024 Apr TI - Spontaneous Spinal Hematoma in Patients Using Antiplatelets and Anticoagulants: A Systematic Review. PG - e185-e194 LID - S1878-8750(24)00094-9 [pii] LID - 10.1016/j.wneu.2024.01.082 [doi] AB - BACKGROUND: Spontaneous spinal hematoma (SSH) is a debilitating complication in patients taking either antiplatelet (AP) or anticoagulation (AC) medications. SSH is rare and, therefore, a systematic review is warranted to re-examine and outline trends, clinical characteristics, and outcomes associated with SSH formation. METHODS: PubMed, EMBASE, Scopus, and Web-of-Science were searched. Studies reporting clinical data of patients with SSH using AC medications were included. In addition, clinical studies meeting our a priori inclusion criteria limited to SSH were further defined in quality through risk bias assessment. RESULTS: We included 10 studies with 259 patients' pooled data post-screening 3083 abstracts. Within the cohort (n = 259), the prevalence of idiopathic, nontraumatic SSH with concomitant treatment with AC medications was greater 191 (73.75%) compared with AP treatment (27%). The lumbar spine was the most common site of hematoma (41.70%), followed by the cervical (22.01%) and thoracic (8.49%) spine. Most patients had surgical intervention (70.27%), and 29.73% had conservative management. The pooled data suggest that immediate diagnosis and intervention are the best prognostic factors in clinical outcomes. American Spinal Injury Association grading at initial symptom onset and post-treatment showed the greatest efficacy in symptomatic relief (87.64%) and return of motor and sensory symptoms (39.19%). CONCLUSIONS: Our review suggested that AC medications were related to SSH in most patients (74%), followed by APs (27%) and combined ACs + APs (1.9%). We recommend prompt intervention, a high suspicion for patients with neurologic deficits and diagnostic imaging before intervention to determine a case-specific treatment plan. CI - Copyright (c) 2024 Elsevier Inc. All rights reserved. FAU - Kumar, Nitesh AU - Kumar N AD - Clinical Medicine, Windsor University School of Medicine, Chicago, Illinois, USA. FAU - Palmisciano, Paolo AU - Palmisciano P AD - Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA. FAU - Dhawan, Sanjay AU - Dhawan S AD - Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA. FAU - Boakye, Maxwell AU - Boakye M AD - Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA. FAU - Drazin, Doniel AU - Drazin D AD - Department of Neurosurgery, Providence Everett Neuroscience Center, Everett, Washington, USA. FAU - Sharma, Mayur AU - Sharma M AD - Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address: drmayursharmaneuro@gmail.com. LA - eng PT - Journal Article PT - Systematic Review DEP - 20240124 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 RN - 0 (Anticoagulants) SB - IM MH - Humans MH - Anticoagulants/adverse effects MH - *Hematoma, Epidural, Spinal/etiology MH - *Spinal Cord Diseases/complications MH - Lumbar Vertebrae MH - Risk Assessment MH - Magnetic Resonance Imaging/adverse effects OTO - NOTNLM OT - Anticoagulation OT - Antiplatelets OT - Epidural hematoma OT - Laminectomy OT - Paraparesis OT - Spinal cord OT - Spontaneous spinal hematoma OT - Systematic review EDAT- 2024/01/27 12:42 MHDA- 2024/04/10 06:43 CRDT- 2024/01/26 19:13 PHST- 2023/09/20 00:00 [received] PHST- 2024/01/13 00:00 [revised] PHST- 2024/01/16 00:00 [accepted] PHST- 2024/04/10 06:43 [medline] PHST- 2024/01/27 12:42 [pubmed] PHST- 2024/01/26 19:13 [entrez] AID - S1878-8750(24)00094-9 [pii] AID - 10.1016/j.wneu.2024.01.082 [doi] PST - ppublish SO - World Neurosurg. 2024 Apr;184:e185-e194. doi: 10.1016/j.wneu.2024.01.082. Epub 2024 Jan 24.