Department of Rheumatology, St. James Hospital, James's Street, Dublin, Ireland,
Clin Rheumatol. 2013 Dec;32(12):1811-4. doi: 10.1007/s10067-013-2350-z. Epub 2013 Aug 8.
Performance of joint and soft tissue injections in patients receiving anticoagulation is subject to different protocols, some of which suggest continuing treatment within the therapeutic range, while others recommend stopping the treatment prior to procedures. The aim of this study was to evaluate the safety of two approaches to the management of patients prescribed warfarin requiring joint or soft tissue injection. A systematic literature review on this subject was undertaken. Our departmental protocol was changed from one where anticoagulation treatment was temporarily stopped prior to joint/soft tissue injection to one where treatment was continued in the context of a therapeutic international normalised ratio (INR) level within 24 h of the procedure. In patients in whom warfarin was withheld, 32 procedures were performed in 18 patients (13 rheumatoid arthritis, 11 osteoarthritis, 5 spondyloarthritis and 1 each of adhesive capsulitis, rotator cuff tendinopathy and trochanteric bursitis). Of these, 30 were joint injections and 2 were soft tissue injections. In patients who continued warfarin, 32 procedures were performed in 21 patients (11 rheumatoid arthritis, 7 osteoarthritis, 6 crystal arthritis, 4 rotator cuff tendinopathy, 2 spondyloarthritis and 1 each of adhesive capsulitis and carpal tunnel syndrome). Of these, 27 were joint injections and 5 were soft tissue injections. There were no clinical hemarthroses or complications in either group. Joint and soft tissue injections appear to be safe in patients receiving warfarin anticoagulation with an INR <3. Continuation of anticoagulants reduces staff workload and patient inconvenience with no evidence of increased risk of complications.
在接受抗凝治疗的患者中，关节和软组织注射的操作需要遵循不同的方案，一些方案建议在治疗范围内继续治疗，而另一些方案则建议在进行操作之前停止治疗。本研究旨在评估两种处理接受华法林治疗且需要关节或软组织注射的患者的方法的安全性。我们对这个主题进行了系统的文献回顾。我们科室的方案从在关节/软组织注射前暂时停止抗凝治疗的方案，更改为在治疗范围内继续治疗，国际标准化比值（INR）水平在操作后 24 小时内保持在治疗范围内。在停止使用华法林的患者中，18 名患者（13 名类风湿关节炎患者、11 名骨关节炎患者、5 名脊柱关节炎患者，各有 1 名粘连性囊炎、肩袖肌腱炎和转子滑囊炎患者）中进行了 32 次操作。其中，30 次为关节注射，2 次为软组织注射。在继续使用华法林的患者中，21 名患者（11 名类风湿关节炎患者、7 名骨关节炎患者、6 名晶体关节炎患者、4 名肩袖肌腱炎患者、2 名脊柱关节炎患者，各有 1 名粘连性囊炎和腕管综合征患者）中进行了 32 次操作。其中，27 次为关节注射，5 次为软组织注射。两组均无临床关节积血或并发症。INR<3 时，接受华法林抗凝治疗的患者进行关节和软组织注射似乎是安全的。继续抗凝治疗可减少工作人员的工作量和患者的不便，且无并发症风险增加的证据。
