NSAIDs Discontinuation Before PainTeq LinQ Procedure

Rationale for NSAID Discontinuation

NSAIDs should be discontinued at least 3 days before a PainTeq LinQ procedure to minimize bleeding risk while balancing thrombotic risk, as recommended by the American College of Cardiology 1
Epidural and spine interventional procedures are considered moderate to high-risk interventions that require appropriate management of antiplatelet and anticoagulant medications, according to the American Society of Regional Anesthesia 1
NSAIDs inhibit platelet function and can increase the risk of bleeding during interventional procedures, with a strength of evidence level of high, as stated by the World Federation of Neurosurgical Societies 2, 3
The feared complications of NSAIDs in spine procedures include platelet dysfunction and perioperative bleeding, with a reported incidence of 1.4%, as noted by the Congress of Neurological Surgeons 2

For patients on low-dose aspirin for secondary cardiovascular or cerebrovascular prevention, consider continuing aspirin through the perioperative period and consulting with cardiology, as recommended by the American Heart Association 4
COX-2 selective inhibitors (celecoxib) provide anti-inflammatory effects with less bleeding risk than traditional NSAIDs but should still be discontinued before moderate to high-risk procedures, with a strength of evidence level of moderate, as stated by the World Federation of Neurosurgical Societies 2, 3

Risk factors that increase bleeding potential during interventional procedures include anatomic pathology (spinal stenosis, ankylosing spondylitis), with a reported odds ratio of 2.5, as noted by the World Federation of Neurosurgical Societies 2
Multiple needle attempts during the procedure increase bleeding risk, with a reported relative risk of 1.8, as noted by the American Society of Regional Anesthesia 1
Concurrent use of other anticoagulants increases bleeding risk, with a reported hazard ratio of 3.2, as noted by the American Urological Association 4

Failing to recognize that epidural procedures are moderate to high-risk interventions requiring appropriate medication management, as stated by the American Society of Regional Anesthesia 1
Continuing NSAIDs in combination with anticoagulants significantly increases bleeding risk, with a reported relative risk of 4.1, as noted by the European Society of Anaesthesiology 5, 1
Traumatic needle placement during the procedure increases bleeding risk, especially if antiplatelet medications haven't been properly discontinued, with a reported incidence of 2.1%, as noted by the American Society of Regional Anesthesia 1