Comment on the Paper Entitled ‘Haemostasis and Safety Measures before Lumbar Puncture at the Haematology Ward: The Danish Routines'

brovascular disorders [2, 4] . It is no wonder that a significant proportion of patients with cardiovascular, cerebrovascular, or peripheral vascular disease who receive antithrombotic therapy also undergo surgical interventions and other interventional techniques, including lumbar punctures. The risks of withdrawing antiplatelet therapy include cardiovascular, cerebrovascular, and peripheral vascular thrombosis which may result in ominous consequences, including stroke and death [4] . In addition, ceasing antiplatelet therapy may result in either hypercoagulability with thrombosis or bleeding complications. By the same token, studies assessing the risk of maintaining antiplatelet therapy have shown an increased surgical blood loss of 2.5–20% with aspirin and 30–50% with aspirin and clopidogrel [2] . In addition, while there has been no increase in surgical mortality due to increased bleeding except during intracranial surgery, increased transfusions and mortality linked to massive surgical blood loss of less than 3% have been reported [2, 5] . Overall, however, the risks of withdrawing antiplatelet therapy are substantial due to a possible rebound effect resulting in increased platelet adhesiveness and hypercoagulability. There are also multiple reports of bleeding risk associated with continuing antiplatelet therapy [2] .The general In this issue of Acta Haematologica, Møller et al. [1] assess the role of hemostasis and safety measures before lumbar puncture in hematology wards in Denmark. The results are not surprising. In an online survey, questions pertaining to the precautions of hemostasis and the application of fundoscopy were sent by e-mail to 12 hematology wards in Denmark, of which 11 participated. The results were highly variable, with 64% of the participating units establishing an international normalized rate limit of 1.5, and the remaining units establishing a limit between 1.0 and 2.5. Surprisingly, 36% of the departments utilized fundoscopy routinely. Platelet counts were also utilized in some units. More importantly, 45% reported no cessation of antiplatelet drug therapy. Consequently, the authors called for national guidelines to establish an evidence-based approach to handle patients at risk of bleeding when lumbar puncture or another invasive procedure is indicated. Cardiovascular and cerebrovascular diseases are among the leading causes of significant impairment of physical and psychological health and performance of social responsibilities, including work and family life. These diseases are leading causes of morbidity and mortality [2, 3] . Antithrombotic therapy has been established to limit the present and future burden of cardiovascular and cereReceived: May 9, 2014 Accepted: May 11, 2014 Published online: September 20, 2014