The risk of lumbar puncture (LP) hemorrhagic complications is believed to be exacerbated by thrombocytopenia, yet evaluations in clinical practice are lacking. We conducted a retrospective cohort study to examine the risk of traumatic tap (TT) and significant hemorrhagic complications in thrombocytopenic patients undergoing bedside LP. Two hundred sixty-two adult patients undergoing initial bedside LP were analyzed. Overall, we observed 37 TTs (14.1%, 95% CI 10.0 to 18.3%). TTs occurred in 11 of 78 LPs performed on patients with thrombocytopenia, compared with 26 of 184 LPs among patients with a normal platelet count (14.1% vs 14.1%; p > 0.99) and 6 of 19 LPs among patients with severe thrombocytopenia compared with 31 of 243 among those without (31.6% vs 12.8%; p = 0.04). For patients with severe thrombocytopenia, the relative risk of TT was 2.5 (95% CI 1.2 to 5.2; p = 0.02). Stratifying this group by operator experience, a higher incidence of TTs was observed in LPs performed by trainees (57.1% vs 15.8%; p = 0.02), an effect which did not reach significance in LPs performed by dedicated procedural operators (16.7% vs 10.8%; p = 0.63). The presence of other bleeding risk factors was not found to be statistically associated with the incidence of TT. There were no significant hemorrhagic complications. TTs occurred significantly more frequently among patients with severe thrombocytopenia, an effect modulated by operator experience. For patients in this higher risk group, LPs should be performed by the most skilled operators available.

人们认为血小板减少症会加剧腰椎穿刺（LP）出血并发症的风险，但缺乏临床实践的评估。我们进行了一项回顾性队列研究，以检查接受床旁LP的血小板减少患者的创伤性水龙头（TT）和重大出血并发症的风险。分析了262名接受初始床旁LP的成年患者。总体而言，我们观察到了37个TT（14.1％，95％CI 10.0至18.3％）。血小板减少症患者进行的78例LP中有11例发生了TT，血小板计数正常的患者中184 LP中的26例中发生了TT（14.1％vs 14.1％；p  > 0.99），严重血小板减少症患者中19 LP中的6例中有31例发生243人中没有（31.6％vs 12.8％; p = 0.04）。对于患有严重血小板减少症的患者，TT的相对风险为2.5（95％CI为1.2至5.2；p  = 0.02）。根据操作员的经验来划分该组，在受训人员执行的LP中观察到TT的发生率较高（57.1％对15.8％；p  = 0.02），在专用程序操作员执行的LP中影响不明显（16.7％对10.8） ％; p = 0.63）。没有发现其他出血危险因素与TT发生率在统计学上相关。没有明显的出血并发症。严重血小板减少症患者中TT的发生频率更高，这是由操作者的经验调节的。对于高危人群，应由最熟练的操作员进行LP。