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Minerva

Health at sea . . . and other stories

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2281 (Published 31 May 2018) Cite this as: BMJ 2018;361:k2281

Re: Health at sea . . . and other stories

With regards to the section entitled "Lumbar Puncture", we would like to comment on the lack of haemorrhagic complications seen in patients taking dual anti-platelet therapy. This study takes a very interesting look at the possibility of an overestimated risk of haemorrhagic complications during lumbar puncture, although the authors themselves state that the study is too small to properly assess the incidence of these adverse events.

We would draw attention to the National Audit Project 3 (Major Complications of Central Neuraxial Block in the United Kingdom) carried out by the Royal College of Anaesthetists. In over 700,00 procedures the project identified eight cases of vertebral canal haematoma. Seven of these patients had received medication that affected coagulation and only one patient was able to make a full neurological recovery. Therefore we would suggest that despite a low relative risk, this project highlights the often severe consequences of haemorrhagic complications.

A pre-procedure checklist, such as the "Reflect before you inject" poster (Anaesthesia, March 2014) may be of use to help prevent these complications. This strategy helps to ensure that causes of altered coagulation are considered prior to a neuraxial procedure being carried out.

NAP3: https://www.rcoa.ac.uk/nap3

Reflect before you inject: https://onlinelibrary.wiley.com/doi/full/10.1111/anae.12609

Competing interests: No competing interests

07 June 2018
Leo Urquhart
Anaesthetic CT1
Dr Vincent Perkins, Consultant Anaesthetist
NHS Dumfries and Galloway
Anaesthetic Department, Dumfries and Galloway Royal Infirmary