Safety of Joint Puncture in Patients Receiving Anticoagulant Therapy With Dabigatran

Astete, Carlos Antonio Guillén; Tinedo, María Terán; Torres, Jose Renato Quiñones; Alarcón, Mónica Luque; Boteanu, Alina

doi:10.1016/j.reumae.2017.01.002

Cited by 3 publications

(10 citation statements)

References 8 publications

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“…Similarly, Yui et al 10 assessed reattendance at the emergency department, outpatients, or hospital admission, Bashir et al 11 assessed attendance at the Emergency Department and Primary Care, and Conway et al 14 assessed contact with the helpline number or a medical practitioner. This would have likely increased the detection of complications compared with the other studies where follow-up was via assessment of presentation to one health care environment only 12,15 …”

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%

“…This would have likely increased the detection of complications compared with the other studies where follow-up was via assessment of presentation to one health care environment only. 12,15…”

Section: Study Qualitymentioning

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%

Section: Resultsmentioning

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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“…[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%

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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“…These findings reflect results of a retrospective review of musculoskeletal procedures with DOAC continuation of rivaroxaban, apixaban, and dabigatran, and including combination therapy, with a 14 days follow‐up (Yui et al., 2017), of an inpatient setting (Nord et al., 2019) and several spinal procedures with DOAC continuation (Ehsanian et al., 2020). A study of 117 procedures with dagabigatran continuation reported one haemarthrosis (Guillen‐Astete et al., 2017). The current study adds to this accumulating evidence of safety that continuation of DOACs is a low risk strategy with musculoskeletal procedures against the risks with interruption (Brennan et al., 2019; Kotecha et al., 2022; Tarar et al., 2021).…”

Section: Discussionmentioning

confidence: 99%

Peri‐procedural management and incidence of bleeding events following musculoskeletal injections or aspirations in people on oral anticoagulation and antiplatelet therapy

McCrum

Furner

Grainger

2023

Musculoskeletal Care

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BackgroundCorticosteroid injections and aspirations are common interventions for managing musculoskeletal and inflammatory conditions. However, there remains limited safety evidence to support injection decisions and peri‐procedural management in people on anti‐thrombotics, particularly for direct oral anticoagulants (DOACs).ObjectivesTo investigate peri‐procedural management and bleeding complications following musculoskeletal injections or aspirations with anti‐thrombotic medication use.DesignA prospective observational study was undertaken (October 2018–December 2020) in Orthopaedics, Rheumatology and Radiology specialities in two large UK healthcare providers. Data collection involved weekly identification of musculoskeletal procedures, emergency attendance or admission within 30 days and follow‐up questionnaires sent within 2 weeks post‐procedure. Descriptive statistics were used to analyse anticoagulant/anti‐platelet use, peri‐procedural management and bleeding complications.ResultsOf 5080 procedures, 237 of 1338 responses reported antithrombotic use: warfarin (n = 36), DOACs (n = 75) and antiplatelets (n = 126). There were no self‐report or electronic identification of clinically significant bleeding events/complications. Only local bruising was reported (8.6% vs. 0.2% with non‐use), and only with medication continuation or international normalised ratio (INR) levels ≥3.8 or unknown. Only 3/72 DOAC use was interrupted.ConclusionsIn this study, no clinically significant bleeding events or complications were reported or identified following musculoskeletal injections or aspirations, with only localised bruising reported. It was not universal practice to check INR levels and DOAC interruption was uncommon. Findings add evidence that musculoskeletal procedures appear to be low risk procedures for bleeding complications with antithrombotic continuation and when INR levels within lower target range. Research on intra‐articular or soft tissue iatrogenic consequences would add to risk/benefit evaluations.

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Safety of Joint Puncture in Patients Receiving Anticoagulant Therapy With Dabigatran

Cited by 3 publications

References 8 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

EULAR recommendations for intra-articular therapies

Peri‐procedural management and incidence of bleeding events following musculoskeletal injections or aspirations in people on oral anticoagulation and antiplatelet therapy

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