Arthrocentesis and Joint Injection in Patients Receiving Direct Oral Anticoagulants

Yui, Jennifer; Preskill, Carina; Greenlund, Laura S.

doi:10.1016/j.mayocp.2017.04.007

Cited by 32 publications

(36 citation statements)

References 11 publications

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“… 61 In another large retrospective study, no bleeding was reported in 1050 procedures performed in 483 patients on rivaroxaban (52%), apixaban (31%) or dabigatran (17%). 62 Several panellists suggested that local pressure to prevent bleeding may be more important after injecting deeper joints than superficial ones.…”

Section: Resultsmentioning

confidence: 99%

“…[44][45][46][47][48][49][50][51][52][53][54][55][56][57] Based on seven observational studies, the estimated periprocedure bleeding risk in patients on antithrombotic drugs (antiplatelet agents, low-molecular weight heparin, warfarin or direct oral anticoagulants) was found to be between 0% and 2%. [58][59][60][61][62][63] One of the larger studies, retrospectively reviewed 640 procedures (arthrocentesis and joint injections) in 514 patients taking warfarin; they found no significant difference in early and late complications in patients receiving therapeutic warfarin (INR 2-3) compared with nontherapeutic levels (INR <2). 61 In another large retrospective study, no bleeding was reported in 1050 procedures performed in 483 patients on rivaroxaban (52%), apixaban (31%) or dabigatran (17%).…”

Section: Recommendationmentioning

confidence: 99%

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EULAR recommendations for intra-articular therapies

et al. 2021

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ObjectivesTo establish evidence-based recommendations to guide health professionals using intra-articular therapies (IAT) in adult patients with peripheral arthropathies.MethodsA multidisciplinary international task force established the objectives, users and scope and the need for background information, including systematic literature reviews) and two surveys addressed to healthcare providers and patients throughout Europe. The evidence was discussed in a face-to-face meeting, recommendations were formulated and subsequently voted for anonymously in a three-round Delphi process to obtain the final agreement. The level of evidence was assigned to each recommendation with the Oxford levels of evidence.ResultsRecommendations focus on practical aspects to guide health professionals before, during and after IAT in adult patients with peripheral arthropathies. Five overarching principles and 11 recommendations were established, addressing issues related to patient information, procedure and setting, accuracy, routine and special aseptic care, safety issues and precautions to be addressed in special populations, efficacy and safety of repeated joint injections, use of local anaesthetics and aftercare.ConclusionWe have developed the first evidence and expert opinion-based recommendations to guide health professionals using IAT. We hope that these recommendations will be included in different educational programmes, used by patient associations and put into practice via scientific societies to help improve uniformity and quality of care when performing IAT in peripheral adult joints.

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Section: Resultsmentioning

confidence: 99%

Section: Recommendationmentioning

confidence: 99%

EULAR recommendations for intra-articular therapies

et al. 2021

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“…Furthermore, the clinician performing the SF collection should be made aware if the patient is taking any medications. Available literature data suggests that arthrocentesis might be safely performed in patients receiving warfarin and direct oral anticoagulants without altering their anticoagulation regimen ( 20 , 21 ).…”

Section: Preanalytical Phasementioning

confidence: 99%

Laboratory testing of extravascular body fluids: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Part II – Synovial fluid

Jokić¹,

Kopcinovic

Culej

et al. 2020

Biochem. med. (Online)

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Joint diseases are conditions with an often progressive and generally painful nature affecting the patient’s quality of life and, in some cases, requiring a prompt diagnosis in order to start the treatment urgently. Synovial fluid (SF) laboratory testing is an important part of a diagnostic evaluation of patients with joint diseases. Laboratory testing of SF can provide valuable information in establishing the diagnosis, be a part of a patient’s follow-up and treatment with the purpose of improving the patient’s health and quality of life. Synovial fluid laboratory testing is rarely performed in Croatian medical biochemistry laboratories. Consequently, procedures for SF laboratory testing are poorly harmonized. This document is the second in the series of recommendations prepared by the members of the Working group for extravascular body fluid samples of the Croatian Society of Medical Biochemistry and Laboratory Medicine. It addresses preanalytical, analytical, and postanalytical issues and the clinical significance of tests used in SF laboratory testing with the aim of improving the value of SF laboratory testing in the diagnosis of joint diseases and assisting in the achievement of national harmonization. It is intended for laboratory professionals and all medical personnel involved in synovial fluid collection and testing.

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“…40 Nevertheless, a retrospective study of 483 patients on NOACs who underwent 1,050 joint or bursa aspirations and injections at a single center provides some evidence for the safety of continuing NOACs for arthrocentesis. 41 Patients were excluded if NOAC therapy was withheld before the procedure. No bleeding complications were reported in any of the 1,050 procedures during median time to follow-up of 5 days.…”

Section: Arthrocentesismentioning

confidence: 99%

To Maintain or Cease Non–Vitamin K Antagonist Oral Anticoagulants Prior to Minimal Bleeding Risk Procedures: A Review of Evidence and Recommendations

Brennan

Favaloro

Curnow

2019

Semin Thromb Hemost

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For procedures associated with minimal bleeding risk, there are data and experience to support the practice of continuing vitamin K antagonists rather than interrupting therapy, to prevent exposing patients to the undue risk of developing thromboembolism during anticoagulation cessation. Despite the increasing use of non–vitamin K oral anticoagulants (NOACs), there is little evidence to guide the management of these drugs around minimal bleeding risk procedures. This review examines and discusses the major society guidelines and recommendations addressing the management of NOACs around minimal bleeding risk procedures. Additionally, it summarizes the existing evidence, and highlights the gaps in knowledge where evidence is not yet available. Finally, recommendations are made to assist the proceduralist deal with this area of limited evidence.

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Arthrocentesis and Joint Injection in Patients Receiving Direct Oral Anticoagulants

Cited by 32 publications

References 11 publications

EULAR recommendations for intra-articular therapies

EULAR recommendations for intra-articular therapies

Laboratory testing of extravascular body fluids: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Part II – Synovial fluid

To Maintain or Cease Non–Vitamin K Antagonist Oral Anticoagulants Prior to Minimal Bleeding Risk Procedures: A Review of Evidence and Recommendations

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