Collagenase Injections in Patients on Warfarin

Dickson, David; Hayton, Mike

doi:10.1016/j.jhsa.2014.10.052

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…37 Dickson and Hayton completed and published an informal poll of 21 hand surgeons and concluded that it was likely safe to use collagenase clostridium histolyticum in patients taking warfarin. 34 Although there is similar anecdotal evidence to support its use, there are no clinical studies specifically addressing the use of collagenase clostridium histolyticum in the anticoagulated patient. This study reviewed 197 patients who had 388 collagenase clostridium histolyticum injections for treatment of Dupuytren contracture.…”

Section: Discussionmentioning

confidence: 99%

“…Dickson and Hayton completed an informal poll of 21 hand surgeons and concluded that it was 915e likely safe to use collagenase clostridium histolyticum in patients taking warfarin. 34 Meals and Hentz published their tips for collagenase clostridium histolyticum injection and suggested that anticoagulation should not be a rigid contraindication. 35 They emphasized the need for clarification of the safety of collagenase clostridium histolyticum use in anticoagulated patients.…”

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The Effect of Anticoagulation on the Treatment of Dupuytren Contracture with Collagenase

Noland

Paul

Pflibsen

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: There have been no formal studies of the use of collagenase clostridium histolyticum (Xiaflex; Endo Pharmaceuticals, Malvern, Pa.) in the anticoagulated patient. Previous study on its use excluded patients receiving anticoagulation therapy. This study reviewed the effects of anticoagulation use in patients undergoing collagenase clostridium histolyticum injection and cord rupture to determine safety and efficacy. Methods: The authors retrospectively reviewed patients receiving collagenase clostridium histolyticum injections for Dupuytren contracture between 2010 and 2017. Outcomes included type of anticoagulation, skin tear, tendon rupture, lymphadenopathy, sensory abnormality, hematoma, and bleeding. Results: A total of 388 injections were performed in 197 patients. The average clinical follow-up was 311 days. Fifty-two percent of patients (n = 201) were anticoagulated. The vast majority were taking aspirin (acetylsalicylic acid) (n = 182), followed by warfarin (n = 27), clopidogrel (n = 9), apixaban (n = 8), rivaroxaban (n = 4), and dabigatran (n = 2). There were 42 skin tears, 21 in the anticoagulated group. One tendon rupture occurred in the anticoagulated group (acetylsalicylic acid) and none occurred in the nonanticoagulated group (p = 0.34). No patients experienced sensory abnormalities, a hematoma requiring intervention, or uncontrollable bleeding. Conclusions: Anticoagulation is commonly encountered by hand surgeons treating Dupuytren contracture. There is no significant difference in complications in the anticoagulated patient versus the nonanticoagulated patient. It is safe to perform collagenase clostridium histolyticum injections for Dupuytren contracture in the anticoagulated patient, regardless of the type of anticoagulation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The Effect of Anticoagulation on the Treatment of Dupuytren Contracture with Collagenase

Noland

Paul

Pflibsen

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Treatment of Dupuytren Contracture With Collagenase Is Safe in the Anticoagulated Patient

Noland¹,

Paul²,

Pflibsen³

et al. 2018

The Journal of Hand Surgery

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There is no financial information to disclose. Hypothesis: It is safe to perform collagenase injections for the treatment of Dupuytren contracture in the anticoagulated patient. Methods: A retrospective review of all patients receiving collagenase injections for Dupuytren contracture by 2 surgeons between 2010 and 2017 was performed. Outcomes evaluated included demographics, type of anticoagulation, skin tear, tendon rupture, lymphadenopathy, sensory abnormality, hematoma, and bleeding. Statistical analysis included chi-square and Fisher exact tests. Results: There were a total of 388 injections performed in 197 patients. Treated locations included the first web space (n ¼ 4), thumb (n ¼ 7), index (n ¼ 11), middle (n ¼ 47), ring (n ¼ 104), and little fingers (n ¼ 215). 77% of patients were male (n ¼ 152), and 23% female (n ¼ 45). Average age was 66 years. Average time to manipulation was 2.75 days. Average followup was 311 days. 10 patients did not receive manipulation owing to autorupture. Of the 388 procedures, 52% of the patients (n ¼ 201) were anticoagulated. The majority were taking aspirin (91%, n ¼ 182), followed by warfarin (13%, n ¼ 27), clopidogrel (4%, n ¼ 9), apixaban (4%, n ¼ 8), rivaroxaban (2%, n ¼ 4), and dabigatran (1%, n ¼ 2). Several patients were taking multiple anticoagulants. There were 42 skin tears (11%): 21 in the anticoagulated group (10%) and 21 in the not-anticoagulated group (11%) (P ¼ .80). 86% of the skin tears occurred in patients taking aspirin (n ¼ 18), and 14% warfarin (n ¼ 3). Subgroup analysis determined no significant difference for aspirin-related skin tears (P ¼ .68) or warfarin-related skin tears (P ¼ .99). There was one tendon rupture in the anticoagulated group (aspirin) and no tendon ruptures in the not-anticoagulated group (P ¼ .34). Lymphadenopathy was present in 7 patients in the anticoagulated group (3%), and 11 patients in the not-anticoagulated group (6%) (P ¼ .26). 71% of patients with lymphadenopathy were taking aspirin (n ¼ 5), and 29% apixaban (n ¼ 2). While not statistically significant, 25% of patients on apixaban had lymphadenopathy (2/8), compared with 2.8% of all other patients; greater power is required to determine if this was meaningful. No patients experienced sensory abnormalities, a hematoma requiring intervention, or uncontrollable bleeding. Summary Points:Anticoagulation, particularly aspirin use, is commonly encountered by hand surgeons treating Dupuytren contracture.There is no significant difference in complications in the anticoagulated patient versus the not-anticoagulated patient.It is safe to perform collagenase injections for Dupuytren contracture in the anticoagulated patient, regardless of the type of anticoagulation.

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Risk Factors for Skin Tears Following Collagenase Clostridium histolyticum to Treat Dupuytren Contractures

Wei¹,

Cantlon²,

Wakefield

et al. 2020

The Journal of Hand Surgery

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Collagenase Injections in Patients on Warfarin

Cited by 3 publications

References 3 publications

The Effect of Anticoagulation on the Treatment of Dupuytren Contracture with Collagenase

The Effect of Anticoagulation on the Treatment of Dupuytren Contracture with Collagenase

Treatment of Dupuytren Contracture With Collagenase Is Safe in the Anticoagulated Patient

Risk Factors for Skin Tears Following Collagenase Clostridium histolyticum to Treat Dupuytren Contractures

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