Spontaneous Spinal Hematoma in Patients Using Antiplatelets and Anticoagulants: A Systematic Review.

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 reexamine 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 ACs were included. In addition, clinical studies meeting our apriori inclusion criteria limited to SSH were further defined in quality through risk bias assessment.

RESULTS: We included ten studies with 259 patients' pooled data post-screening 3083 abstracts. Within the cohort (n = 259), the prevalence of idiopathic, non-traumatic SSH with concomitant ACs treatment was higher 191 (73.75%) compared to APs 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. Using American Spinal Injury Association (ASIA) grading at initial symptom onset and post-treatment showed the highest efficacy in symptomatic relief (87.64%) and return of motor and sensory symptoms (39.19%).

CONCLUSIONS: Our review suggested that ACs was 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 neurological deficits, and diagnostic imaging before intervention to determine a case-specific treatment plan.