There is wide variance in practice when it comes to performing needle electrode examination (NEE) in patients on antiplatelet or anticoagulant medications, including no change in routine practice, refusal to perform NEE, limiting NEE to certain muscles, and requiring patients to stop taking the medications until the perceived risk is reduced. The variability in practice is likely a result of electrodiagnostic (EDX) practitioners' desire to ''first do no harm'' in the absence of good data or clear guidelines. A survey of 47 EDX laboratories with ACGME-approved fellowships reported that about 80% restrict their NEE practice in some way for anticoagulated patients and that nearly 20% alter protocols in patients taking antiplatelet agents. 1 To date, there have been 5 case reports of symptomatic bleeding-related complications from NEE, and 3 of these required surgery. 2-6 However, only 2 of these patients were taking warfarin and, in 2 of the 5 cases there is room for doubt that the NEE actually caused the hemorrhage. The case reports do not implicate particular patient factors, medications, or technique as the cause for the hemorrhages. In the survey of EDX laboratories represents recalled a total of 5 bleeding complications from NEE requiring intervention, and all involved anticoagulated patients. 1 As many of the respondents were senior laboratory directors, the "n" here would be many thousands of EDX procedures performed over several decades. None of the lab directors could remember a similar incident in those taking antiplatelet agents. The paucity of case reports suggests that symptomatic hematomas are exceedingly rare as a result of NEE, but the recalled and reported anecdotes have prompted most EDX labs to restrict their practice in anticoagulated patients.
Several attempts have been made to study the incidence of bleeding from NEE. In 1996, Caress et al. published findings from a consecutive sample