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Lumbar Puncture and Anticoagulant Therapy-Reply

John C. M. Brust, MD; Henry D. Messer, MD
JAMA. 1976;235(25):2716. doi:10.1001/jama.1976.03260510010004.
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In Reply.—  Wee agree with Dr Woolf that the clotting deficit contributed to this lady's spinal hematoma; as the subtitle stated, it is "a consequence of anticoagulant therapy." However, severe low back pain and tenderness at the site of the lumbar puncture were prominent complaints that focused attention on the lumbar puncture as the cause of bleeding. The myelogram from above showed the hematoma to extend all the way to the neck, but attempted repeat punctures at L5-S1 and L3-4 had already disclosed old blood in the lumbar area.Spinal hematomata may be spontaneous or traumatic (including the trauma of lumbar puncture) and may occur with or without the use of anticoagulants. In our patient, both factors appeared to play a role.Regarding Dr Woolf's dislike of anticoagulants, the value of such therapy in cardiac embolic stroke is supported by data.1


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