Determination of a safe INR for joint injections in patients taking warfarin

Bashir, MA; Ray, Robin; Sarda, Praveen; Li, S; Corbett, Steven A

doi:10.1308/rcsann.2015.0044

Cited by 16 publications

(29 citation statements)

References 11 publications

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“…Five of the studies were medical records review studies 9–13 . One study (Conway et al 14 ) considered 2 cohorts (one cohort for which a chart review for the previous 6 months was conducted, and the other for which a 6-month longitudinal study was conducted), and one (Guillén Astete et al 15 ) did not state whether the study was a medical records review or a longitudinal one.…”

Section: Resultsmentioning

confidence: 99%

The Safety of Continued Oral Anticoagulation Therapy in Joint Injections and Aspirations

et al. 2022

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Performing joint aspirations and injections on patients taking longterm oral anticoagulants poses a clinical conundrum. This review aimed to quantify the safety of performing joint procedures in these patients in terms of bleeding risk. In addition, it aimed to identify, in those receiving vitamin K antagonists, what level of international normalized ratio (INR) is the safest.A review of the medical literature was performed (electronic searches in Ovid [MEDLINE], EMBASE, and the Cochrane Library). English language original reports of patients undergoing joint injections or aspirations performed on anticoagulant therapy, published within the last 10 years, were included.Seven studies met the inclusion criteria. Patients were taking a variety of anticoagulants: warfarin, acenocoumarol, and direct oral anticoagulants. Four cases of hemorrhage were reported after 5427 procedures, over a pooled 32-year period, across 9 centers. The INR values were available for 3 cases with bleeding complications: values were 1.9, 2.3, and 3.4.Authors of all studies concluded that joint injection is safe in patients on anticoagulants. A variety of joints and approaches, reversal, or withholding of anticoagulation and bridging with low molecular weight heparin did not seem to alter bleeding risk. Bleeding complications remained low even in those with renal or hepatic impairment or those taking concomitant antiplatelets.In conclusion, joint aspiration and injection are safe in patients taking anticoagulants. Anticoagulation should not be routinely discontinued in these patients; decisions should be made on a case-by-case basis. Because of low event numbers, a recommended safe maximum INR value for joint procedures cannot be determined.

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Section: Resultsmentioning

confidence: 99%

The Safety of Continued Oral Anticoagulation Therapy in Joint Injections and Aspirations

et al. 2022

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“…Documenting the patient's symptoms and their intensity (e.g., VAS) is recommended before treatment to allow assessment of clinical results during follow-up. [114][115][116]. Also, the new oral anticoagulants usually do not have to be paused at all or only on the same day as the RSO procedure [117].…”

Section: Information Required Before Rsomentioning

confidence: 99%

The EANM guideline for radiosynoviorthesis

Kampen¹,

Boddenberg-Pätzold

Fischer³

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose Radiosynoviorthesis (RSO) using the intraarticular application of beta-particle emitting radiocolloids has for decades been used for the local treatment of inflammatory joint diseases. The injected radiopharmaceuticals are phagocytized by the superficial macrophages of the synovial membrane, resulting in sclerosis and fibrosis of the formerly inflamed tissue, finally leading to reduced joint effusion and alleviation of joint pain. Methods The European Association of Nuclear Medicine (EANM) has written and approved these guidelines in tight collaboration with an international team of clinical experts, including rheumatologists. Besides clinical and procedural aspects, different national legislative issues, dosimetric considerations, possible complications, and side effects are addressed. Conclusion These guidelines will assist nuclear medicine physicians in performing radiosynoviorthesis. Since there are differences regarding the radiopharmaceuticals approved for RSO and the official indications between several European countries, this guideline can only give a framework that must be adopted individually.

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“…For example, injections in knees and shoulders in patients taking warfarin have been shown to be safe with international normalized ratio (INR) values up to 5.5. 19 However, the hip is a much deeper joint, and it is hardly accessible for compression. Coxo-femoral joint injection is considered to carry a moderate risk of bleeding.…”

Section: Contraindications and Precautions For Usementioning

confidence: 99%

Intraarticular Corticosteroids for Hip Osteoarthritis: A Review

2020

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Introduction Hip osteoarthritis is a prevalent condition responsible for important pain and disability. Most available guidelines for nonsurgical management of hip osteoarthritis recommend a combination of nonpharmacological and pharmacological treatment modalities. Intraarticular corticosteroid injections have been used for decades, although evidence is quite scarce, and many controversies remain. Methods This article reviews the available literature from Medline and Embase and discusses the evidence for intraarticular corticosteroid injections in hip osteoarthritis, where only 5 randomized controlled trials were found in the literature. These are analyzed in this article, which also aims to explain the main characteristics and features of glucocorticoids, along with their contraindications and potential adverse effects. Results Available randomized controlled trials show that intraarticular corticosteroid injections provide pain relief and functional improvement in hip osteoarthritis. This efficacy has not been shown with intraarticular hyaluronic acid injections. Conclusion This review shows that intraarticular corticosteroid injections are efficacious in hip osteoarthritis and that this benefit can last up to 12 weeks.

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Determination of a safe INR for joint injections in patients taking warfarin

Abstract: With a mean INR of 2.77 (range, 1.7-5.5) and a maximum INR within this group of 5.5, joint injections to the shoulder and knee can be undertaken safely in primary or secondary care settings despite the patient taking warfarin.

Cited by 16 publications

References 11 publications

The Safety of Continued Oral Anticoagulation Therapy in Joint Injections and Aspirations

The Safety of Continued Oral Anticoagulation Therapy in Joint Injections and Aspirations

The EANM guideline for radiosynoviorthesis

Intraarticular Corticosteroids for Hip Osteoarthritis: A Review

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