Acute Knee Haemarthrosis: A Case Report Describing Diagnosis and Management for a Patient on Anticoagulation Medication

Ross, Michael D.; Elliott, Ryan

doi:10.1002/pri.491

Cited by 7 publications

(7 citation statements)

References 16 publications

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“…The majority of patients included in this study had their anticoagulation held temporarily which is in keeping with the published literature. 5,10,11,14 There was no significant difference in length of stay between patients in whom the anticoagulant was continued and patients in whom it was held. Warfarin was the most common anticoagulant prescribed to patients in this study.…”

Section: Discussionmentioning

confidence: 90%

“…The majority of patients in the literature received some aspect of the basic rest, ice, compression and elevation (RICE) principles. 5,10,11 In one case report, the affected joint was immobilised for 3 months due to ongoing pain, but there was no evidence to support this practice. 5 Joint aspiration is widely used as both a diagnostic and therapeutic tool in the management of an acute haemarthrosis.…”

Section: Discussionmentioning

confidence: 99%

“…18 Temporary or permanent cessation of the anticoagulant may improve patient symptoms and aid in resolution of the haemarthrosis. 5,10,11,14 In contrast, continuing the anticoagulation has been associated with prolonged symptoms and even recurrent episodes of haemarthrosis. 5,12,19 In more complex cases where anticoagulation cannot be stopped or the patient is experiencing recurrent episodes of haemarthrosis, some experimental techniques have been trialed.…”

Section: Discussionmentioning

confidence: 99%

“…The literature available to guide practice is limited to case reports and small case series. [5][6][7][9][10][11][12][13][14][15][16][17][18] According to current recommendations, a single episode of acute haemarthrosis associated with oral anticoagulants should be managed by rest, ice, compression and elevation (RICE) principles, temporary cessation of anticoagulation where possible and potential aspiration of the joint. 5,[10][11][12][13][14] Our aim was to investigate the approach to these patients in the Orthopaedic Department at a central London District General Hospital over 4 years and highlight the outcomes of different management strategies.…”

Section: Introductionmentioning

confidence: 99%

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Management of Haemarthrosis in Patients On Oral Anticoagulants

Dalrymple

Davies

Biggs

et al. 2022

Geriatr Orthop Surg Rehabil

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Aims Our aim was to investigate the management of patients who were admitted to hospital with an acute haemarthrosis whilst taking oral anticoagulants, and highlight the outcomes of different management strategies. Methods A retrospective review was performed of all orthopaedic admissions over a 42-month period (January 2015–July 2018) to the Orthopaedic Department of a London District General Hospital. All patients admitted with a spontaneous joint haemarthrosis and concomitant use of oral anticoagulants was identified. Anonymised data was placed on a secure trust database. Findings A total of 31 patients were included. 22 patients (71%) had their anticoagulant temporarily held during admission. 9 patients (32%) had their anticoagulation reversed with 10 mg of vitamin K. 5 patients had their haemarthrosis aspirated either on admission or during their hospital stay. The overall mean length of stay in patients with a haemarthrosis was 7.0 days. The mean length of stay in patients who had their anticoagulation held was 8.6 days. In contrast, patients who continued taking their anticoagulation were found to have an average length of stay of 2.3 days. No patients suffered a thrombotic event in the 60 days following discharge. No adverse events were recorded following joint aspiration. Conclusion There is currently no consensus on the management of haemarthrosis in patients on oral anticoagulants. Continuing the anticoagulants did not increase length of hospital stay. Further research may focus on assessing the effect of management adjuncts on patient outcomes and their cost effectiveness to aid the development of local and/or national guidelines.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Management of Haemarthrosis in Patients On Oral Anticoagulants

Dalrymple

Davies

Biggs

et al. 2022

Geriatr Orthop Surg Rehabil

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“…Only patients with exclusive venous events with PT/INR target between 2.0 and 3.0 were selected, since patients with arterial events and higher intensity of anticoagulation would be at higher risk of bleeding during exercise. 21,22 Moreover, only patients with stable warfarin dose and TP/INR control for two months prior to the study were included. In order to define the real effect of acute exercise in coagulation potential, only sedentary PAPS patients and healthy controls were included since regular chronic exercise determines adaptations in blood haemostasis.…”

Section: Subjectsmentioning

confidence: 99%

Avaliação da capacidade aeróbica e do controle autonômico cardíaco em pacientes com síndrome antifosfolípide primária

Garcia

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Acute physical exercise is safe in patients with primary antiphospholipid syndrome with exclusive venous thrombosis and under oral anticoagulation with warfarin

et al. 2014

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The purpose of present study was to evaluate the effects of maximal acute physical exercise on prothrombin time/international normalized ratio (PT/INR) in patients with primary antiphospholipid syndrome (PAPS) under oral anticoagulation with warfarin and the safety of acute exercise in regard to thrombosis and bleeding risk. Eighteen physically inactive women with PAPS (Sydney criteria) with exclusive venous events and without thrombocytopenia were included. All patients were under stable warfarin therapy (PT/INR target: 2.0-3.0). Eighteen age-matched healthy sedentary women without thrombosis/bleeding disorders were selected as controls. All subjects performed a maximal exercise test, and capillary blood samples were obtained pre-, post- and at 1-h post-exercise (recovery time) for PT/INR analysis using a portable CoaguCheck. PAPS patients and controls had similar mean age (31.50 ± 8.06 vs. 29.61 ± 7.05 years, p = 0.46) and body mass index (24.16 ± 3.67 vs. 24.66 ± 2.71 kg/m(2), p = 0.65). PAPS had a mild but significant increase in PT/INR value at 1-h post-exercise (recovery) compared with pre- (2.33 ± 0.34 vs. 2.26 ± 0.29, p = 0.001) and post-exercise (2.33 ± 0.34 vs. 2.26 ± 0.32, p = 0.001) that was observed in 61.11 % of these patients. None of the subjects had thrombotic or bleeding complications related to the acute exercise. Acute exercise in patients with PAPS with exclusive venous thrombosis was safe with a minor increase in PT/INR. This is an important step to introduce regular exercise training as a therapeutic tool in the management of these patients.

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Acute Knee Haemarthrosis: A Case Report Describing Diagnosis and Management for a Patient on Anticoagulation Medication

Abstract: We recommend that physical therapists screen all patients for whether or not they are taking anticoagulation medications, especially before implementation of manual therapy or therapeutic exercise interventions.

Cited by 7 publications

References 16 publications

Management of Haemarthrosis in Patients On Oral Anticoagulants

Management of Haemarthrosis in Patients On Oral Anticoagulants

Avaliação da capacidade aeróbica e do controle autonômico cardíaco em pacientes com síndrome antifosfolípide primária

Acute physical exercise is safe in patients with primary antiphospholipid syndrome with exclusive venous thrombosis and under oral anticoagulation with warfarin

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