Continuing anticoagulants and antiplatelets for patients undergoing lumbar sympathetic ganglion block.
Background and aims
Guidelines have been published that recommend discontinuing anticoagulants and antiplatelets in patients undergoing interventional pain procedures. Although the guidelines categorize lumbar sympathetic ganglion block (LSGB) as an intermediate-risk therapy under medication of anticoagulants and antiplatelets, continuation of them is inevitable in some cases. The present study examined the complications induced by LSGB under continuation of them were examined.
Methods
LSGB was performed in 91 patients with peripheral vascular disease, ages 33 to 89 years, who had either anticoagulants, antiplatelets or both. They had between one and four kinds of these drugs. Hematocrit value (Ht), platelet count, prothrombin time (PT) and activated partial thrombin time (APTT) were checked before LSGB. When Ht decreased, it might be associated with concealed hemorrhage. The patients who were suspected of hemorrhage were followed by abdominal CT examination to check the development of hematoma.
Results
Two patients who showed sinus tachycardia and severe hypotension after the procedure didn’t show Ht decrease. Nineteen patients who showed Ht decrease (3 % or more) didn’t develop hematoma. No correlation between platelet count, PT, and APTT nor Ht decrease was observed. A patient who developed acute myocardial infarction next morning and died later didn’t show Ht decrease.  
Conclusions
Although no obvious hematoma was observed, more than 20 % patients showed unidentified Ht decrease. Relationship of Ht decrease with continuing the drugs is not clear, but it should be concluded that LSGB procedure is more dangerous under continuation the drugs. Patients should be observed after the procedure.

CONTINUING ANTICOAGULANTS AND ANTIPLATELETS FOR PATIENTS UNDERGOING LUMBAR SYMPATHETIC GANGLION BLOCK