SCS implant and thrombocytopenia

[thecentral09]

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Was referred a patient from neurosurgery with a history of thrombocytopenia, as well as lupus anticoagulant and a fib. On anticoagulants, and platelet count typically 70- 90k. They suggested percutaneous placement for permanent implant, due to decreased amount of time being off of anticoagulants. General consensus, what level of thrombocytopenia do you tolerate prior to implantation of SCS WITH STANDARD placement of the thoracic spine. 80k? 100k. The problem I’m running into is the pain physician who did the trial who is not comfortable with doing implants suggested that they would not do the trial at a platelet count list than 120.
Obviously, I have discussed in depth the risks of proceeding if the platelet count does not increase even after giving platelets, and the patient understands and excepts those are us. Just a general question regarding what levels you would all feel comfortable at.

 

[Agast]

Back up a moment - why is the time off anticoagulants less for leads vs paddle implant?

 

[lobelsteve]

Ive done trial at 22k. No issues. Had i known ahead of time, i would have said no. 70k for scs for me. 50k for everything else.

 

[Orin]

50k

As long as the NSGY team is on standby for a hematoma evacuation, I would do a buried perc trial if they're a decent candidate.

 

[thecentral09]

Back up a moment - why is the time off anticoagulants less for leads vs paddle implant?

This specific neurosurgeon wanted off thinners for 1-2 weeks after laminotomy. IDK why

 

[painfree23]

50k

As long as the NSGY team is on standby for a hematoma evacuation, I would do a buried perc trial if they're a decent candidate.

Why buried perc trial?

 

[Orin]

Why buried perc trial?

Anticoagulation held just pretrial, can put the can in while bleeding.