Is It Safe to Perform Joint Infiltrations or Aspirations in Patients Anticoagulated With Acenocoumarol?

Astete, Carlos Antonio Guillén; Boteanu, Alina; Quiñones, Carmen; Montés, Núria; Moll, Fernando Roldán; Carmano, César Carballo; Mendoza, A. Zea

doi:10.1016/j.reumae.2014.03.020

Cited by 2 publications

(18 citation statements)

References 9 publications

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“…There were 2 patients with bleeding complications in the study by Guillén Astete et al, 12 in which all patients were taking acenocoumarol: one (with INR of 3.4) had undergone a knee arthrocentesis, and the other (with INR of 1.9) had undergone an injection to the shoulder joint; both complications occurred within 72 hours of the procedure. Although this study had assessed comorbidities, and about half of patients were taking concurrent antiplatelets, these details are not specified for the individuals who experienced bleeding complications.…”

Section: Resultsmentioning

confidence: 99%

“…The studies by Yui et al, 10 Guillén Astete et al, 12 Ahmed and Gertner, 13 and Guillén Astete et al 15 included injections and arthrocentesis, with the other studies assessing injections only.…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…International normalized ratio values were calculated in 5 of the studies: all of the studies in which patients were taking warfarin (Bashir et al, 11 Ahmed and Gertner, 13 and Conway et al 14 ), as well as the study by Guillén Astete et al 12 where patients were taking acenocoumarol, and 303 of the 483 patients in the study by Yui et al 10 where patients were taking DOACs. Mean INR values and ranges are summarized in Supplemental Table 1, http://links.lww.com/RHU/A455.…”

Section: Resultsmentioning

confidence: 99%

“…The percentage of male patients in studies ranged from 41.7% to 52.5%. Only 3 studies gave details about comorbidities: Yui et al, 10 Guillén Astete et al, 12 and Ahmed and Gertner. 13 Yui et al 10 mentioned that 4.7% of procedures were in individuals with renal impairment (defined as creatinine concentration >1.5 mg/dL), 0.4% in those with hepatic impairment (defined as aspartate aminotransferase or alanine aminotransferase values greater than 3 times the upper limit of normal), and 6.5% in those with thrombocytopenia (platelet count <150 Â 10 9 /L).…”

Section: Demographics and Comorbidities Of Patientsmentioning

confidence: 99%

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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%