A Delphi-Based Consensus Statement on the Management of Anticoagulated Patients With Botulinum Toxin for Limb Spasticity

Boulias, Chris; Ismail, Farooq; Phadke, Chetan P.; Bagg, Stephen; Bureau, Isabelle; Charest, Stephane; Chen, Robert; Cheng, Amy; Ethans, Karen; Fink, Milo; Finlayson, Heather; Gulasingam, Sivakumar; Guo, Meiqi; Haziza, Muriel; Hosseini, Hossein Asghar; Khan, Omar; Lang, Michael; Lapp, Timothy; Leckey, Robert; Shan, Rodney Li Pi; Liem, Nathania; Lo, Alexander; Mason, Mark; McNeil, Stephen; McVeigh, Sonja; Miller, Thomas A.; Mills, Patricia; Naud, Pierre; O’Connell, Colleen; Petitclerc, Marc; Prevost, Julie; Reebye, Rajiv; Richardson, Denyse; Satkunam, Lalith; Sharma, Satyendra Kumar; Short, Christine; Sirois, Geneviève; Unarket, Milan; Wein, Theodore; Wilkins, Kathryn; Winston, Paul

doi:10.1016/j.apmr.2018.04.023

Cited by 9 publications

(13 citation statements)

References 31 publications

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“…Only two EMG studies reported needle sizes, which ranged from 23 gauge to 30 gauge, whereas two BTX studies reported needle sizes from 22 gauge to 27 gauge 9,11,12,17 . In the survey‐based studies, two of the six studies mentioned different needle sizes, with one specifying the use of 25 gauge or smaller needles for the deep compartment of the leg and the other reporting the use of 22 gauge needle in the majority of participating physicians 7,14 . Seven of 12 non–survey‐based studies did not mention needle size.…”

Section: Results Relating To Needle Sizesmentioning

confidence: 99%

Botulinum Toxin Injection and Electromyography in Patients Receiving Anticoagulants: A Systematic Review

Tan

Wee

2020

PM&R

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Objective To identify the different practice patterns of botulinum toxin injection (BTX) and electromyography (EMG) in patients receiving anticoagulation and to evaluate the incidence, reporting, and management of bleeding complications and compartment syndrome from BTX and EMG. Literature Survey Systematic review of relevant clinical studies in PubMed/Medline and Embase databases using key terms from inception to 31 May 2020. All publications in the English language were included without demographic limits. Methodology A comprehensive search was performed to identify all studies addressing BTX and EMG in patients receiving anticoagulants. Two reviewers independently screened the titles, abstracts, and full texts and extracted data based on a set of predefined inclusion and exclusion criteria. All studies that met the inclusion criteria were assigned their respective levels of evidence using the Joanne Briggs Institute (JBI) Level of Evidence for Effectiveness. Synthesis Eighteen studies were included in this review of which there were nine studies each on BTX and EMG. The results indicated heterogeneity in the practice patterns of BTX and EMG in patients taking anticoagulants. These included the decision for continuation of anticoagulant, international normalized ratio (INR) results acceptable to practitioners, the modality for procedure guidance, and surveillance of bleeding complications. In addition, there were variations in the description of targeted muscles and description of needle sizes. The overall incidence of bleeding complications and compartment syndrome rates were low. Conclusions Despite the varied practice in anticoagulated patients undergoing BTX or EMG, practitioners should allow periprocedural continuation of anticoagulants, targeting an INR of 2 to 3 while using the smallest needle (25 gauge or smaller) of appropriate length. Some of the evidence on procedural guidance and complication surveillance were weak and more research in these areas is required.

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Section: Results Relating To Needle Sizesmentioning

confidence: 99%

Botulinum Toxin Injection and Electromyography in Patients Receiving Anticoagulants: A Systematic Review

Tan

Wee

2020

PM&R

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“…Among 47 Chinese experts who participated in this study, senior urologists accounted for 72%, and 98% of them had over a decade of clinical experience in andrology. Two rounds of Delphi question surveys and a hierarchy analysis were used to estimate the consistent tendency of experts’ opinions and measure the authority of participants (Baiocchi et al, 2019; Bardach et al, 2018; Boulias et al, 2018). The results demonstrated that the authority coefficient and the harmony coefficient of the experts on selected primary and secondary properties for the assessment of PE treatment were both high, indicating that experts’ voting on the rationales and weights of PE properties was highly accordant, that is, primary and secondary properties having different levels of importance in the scoring system.…”

Section: Discussionmentioning

confidence: 99%

The Use of Delphi Method and Analytical Hierarchy Process in the Establishment of Assessment Tools in Premature Ejaculation: The Scoring System for Premature Ejaculation Treatment Outcomes

et al. 2020

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There is a lack of objective tools to comprehensively evaluate premature ejaculation (PE) treatment results clinically. We aimed to describe the development of a novel scoring system for PE treatment results as an example of using the Delphi method and an analytical hierarchy process for complex decision-making in the field of sexual medicine. A Delphi question survey was adopted to collect expert opinions from 47 Chinese specialists in andrology/urology on the assessment of PE treatment outcomes based on four primary properties, that is, the improvement in intravaginal ejaculation latency time, a couple’s mental status, the ability to control ejaculation, and sexual intercourse satisfaction. Different weights on those primary properties were assigned to create a mathematical hierarchy matrix and then perform an analysis. The scores were assigned according to the calculated weights. The ratio among the combined weights of the four primary properties was 1:3:2:3. The total numerical score was 36. Scores above 27, between 26 and 18, and below 17 indicated significant improvement, moderate improvement, and no improvement in PE, respectively, with selected treatments. The scoring system with 36 points can be used by physicians, patients, and their sexual partners to comprehensively and objectively assess quantitative PE treatment results.

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“…To the best of our knowledge, there have been no reports on the safety of salivary gland BoNT injection in patients whose INR levels exceeded 3.0. Safety studies and consensus statements related to BoNT injections in patients with oral anticoagulation are limited to intramuscular BoNT injections in cases of blepharospasm, cervical dystonia, and spasticity management, where the INR cut-off levels are either <3.0 or <3.5 [14,15].…”

Section: Discussionmentioning

confidence: 99%

The Challenges Faced and Lessons Learnt in the Multidisciplinary Management of Medication Refractory Post-Stroke Sialorrhea: A Case Report

Lui

Neo

Quah

2020

Cureus

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Post-stroke sialorrhea is a very debilitating condition that negatively impacts a person's physical and psychological health. In this report, we discuss a case of medication refractory post-stroke sialorrhea in a female patient. The patient received multidisciplinary management and two fractions of radiotherapy over a course of five months. The treatment was successful, and the patient reported satisfactory control of her sialorrhea symptoms. We hope to highlight the importance of multidisciplinary management and consideration of radiotherapy as a treatment modality when providing care for medication refractory poststroke sialorrhea patients who are unsuitable for salivary gland botulinum toxin (BoNT) injection and surgery.

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A Delphi-Based Consensus Statement on the Management of Anticoagulated Patients With Botulinum Toxin for Limb Spasticity

Cited by 9 publications

References 31 publications

Botulinum Toxin Injection and Electromyography in Patients Receiving Anticoagulants: A Systematic Review

Botulinum Toxin Injection and Electromyography in Patients Receiving Anticoagulants: A Systematic Review

The Use of Delphi Method and Analytical Hierarchy Process in the Establishment of Assessment Tools in Premature Ejaculation: The Scoring System for Premature Ejaculation Treatment Outcomes

The Challenges Faced and Lessons Learnt in the Multidisciplinary Management of Medication Refractory Post-Stroke Sialorrhea: A Case Report

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