Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients a report from the multicenter perioperative outcomes group

Background: Trombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. Tere is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. Te authors reviewed a large perioperative database and performed a systematic review to further defne the risk of epidural hematoma requiring surgical decompression in this population. Methods: Te authors performed a retrospective cohort study using the Multicenter Perioperative Outcomes Group database to identify thrombocytopenic parturients who received a neuraxial technique and to estimate the risk of epidural hematoma. Patients were stratifed by platelet count, and those requiring surgical decompression were identifed. A systematic review was performed, and risk estimates were combined with those from the existing literature. Results: A total of 573 parturients with a platelet count less than 100,000mm^-3 who received a neuraxial technique across 14 institutions were identifed in the Multicenter Perioperative Outcomes Group database, and a total of 1,524 parturients were identifed after combining the data from the systematic review. No cases of epidural hematoma requiring surgical decompression were observed. Te upper bound of the 95% CI for the risk of epidural hematoma for a platelet count of 0 to 49,000 mm^-3 is 11%, for 50,000 to 69,000mm^-3 is 3%, and for 70,000 to 100,000mm^-3 is 0.2%. Conclusions: Te number of thrombocytopenic parturients in the literature who received neuraxial techniques without complication has been signifcantly increased. Te risk of epidural hematoma associated with neuraxial techniques in parturients at a platelet count less than 70,000mm^-3 remains poorly defned due to limited observations.