Mcculloch Michael, Nachat Arian, Schwartz Jonathan, Casella-Gordon Vicki, Cook Joseph
Research Lead for Integrative Medicine at the Walnut Creek Hospital in CA and a Research Chief at the Pine Street Foundation in San Anselmo, CA.
Director of Integrative Medicine at the Walnut Creek Hospital in CA.
Perm J. 2015 Winter;19(1):68-73. doi: 10.7812/TPP/14-057. Epub 2014 Nov 24.
Theoretically, acupuncture in anticoagulated patients could increase bleeding risk. However, precise estimates of bleeding complication rates from acupuncture in anticoagulated patients have not been systematically examined.
To critically evaluate evidence for safety of acupuncture in anticoagulated patients.
We searched PubMed, EMBASE, the Physiotherapy Evidence Database, and Google Scholar.
Of 39 potentially relevant citations, 11 met inclusion criteria: 2 randomized trials, 4 case series, and 5 case reports. Seven provided reporting quality sufficient to assess acupuncture safety in 384 anticoagulated patients (3974 treatments). Minor-moderate bleeding related to acupuncture in an anticoagulated patient occurred in one case: a large hip hematoma, managed with vitamin K reversal and warfarin discontinuation following reevaluation of its medical justification. Blood-spot bleeding, typical for any needling/injection and controlled with pressure/cotton, occurred in 51 (14.6%) of 350 treatments among a case series of 229 patients. Bleeding deemed unrelated to acupuncture during anticoagulation, and more likely resulting from inappropriately deep needling damaging tissue or from complex anticoagulation regimens, occurred in 5 patients. No bleeding was reported in 2 studies (74 anticoagulated patients): 1 case report and 1 randomized trial prospectively monitoring acupuncture-associated bleeding as an explicit end point. Altogether, 1 moderate bleeding event occurred in 3974 treatments (0.003%).
Acupuncture appears to be safe in anticoagulated patients, assuming appropriate needling location and depth. The observed 0.003% complication rate is lower than the previously reported 12.3% following hip/knee replacement in a randomized trial of 27,360 anticoagulated patients, and 6% following acupuncture in a prospective study of 229,230 all-type patients. Prospective trials would help confirm our findings.
从理论上讲，接受抗凝治疗的患者进行针刺可能会增加出血风险。然而，尚未系统研究过接受抗凝治疗的患者因针刺导致出血并发症的精确发生率。
严格评估接受抗凝治疗的患者进行针刺安全性的证据。
我们检索了PubMed、EMBASE、物理治疗证据数据库和谷歌学术。
在39篇可能相关的文献中，11篇符合纳入标准：2项随机试验、4个病例系列和5篇病例报告。7篇文献报告质量足以评估384例接受抗凝治疗的患者（3974次治疗）针刺的安全性。1例接受抗凝治疗的患者因针刺出现轻至中度出血：出现一个大的臀部血肿，在重新评估其医学合理性后，通过维生素K逆转和停用华法林进行处理。在一个包含229例患者的病例系列中，350次治疗中有51次（14.6%）出现针点出血，这是任何针刺/注射都可能出现的情况，通过按压/棉球即可控制。5例患者出现的出血被认为与抗凝期间的针刺无关，更可能是由于针刺过深损伤组织或复杂的抗凝方案所致。2项研究（74例接受抗凝治疗的患者）未报告出血情况：1篇病例报告和1项将针刺相关出血作为明确终点进行前瞻性监测的随机试验。在3974次治疗中，共发生1例中度出血事件（0.003%）。
假设针刺位置和深度合适，针刺在接受抗凝治疗的患者中似乎是安全的。观察到的0.003%的并发症发生率低于先前在一项针对27360例接受抗凝治疗患者的随机试验中髋关节/膝关节置换术后报告的12.3%，以及在一项针对229230例各类患者的前瞻性研究中针刺后报告的6%。前瞻性试验将有助于证实我们的研究结果。
