Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA(∗).
Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA(†).
PM R. 2017 Dec;9(12):1217-1224. doi: 10.1016/j.pmrj.2017.06.002. Epub 2017 Jun 16.
Patients receiving anticoagulation or antiplatelet therapy may be at higher risk for bleeding complications following intramuscular chemodenervation injections. Musculoskeletal ultrasound may be able to reduce the risk of bleeding complications by providing real-time visualization of vascular structures and postinjection monitoring. Limited data exist addressing the risk of bleeding complications following ultrasound-guided botulinum neurotoxin intramuscular chemodenervation procedures in the setting of anticoagulation or antiplatelet therapy.
To provide initial outcome data regarding bleeding complications in patients on anticoagulation or antiplatelet therapy who have received ultrasound-guided botulinum neurotoxin intramuscular chemodenervation procedures.
Retrospective, medical record review.
Academic institution outpatient spasticity clinic.
Total of 328 ultrasound-guided intramuscular botulinum toxin injections performed in 15 patients (mean age 53.8 years) with the predominant indication for chemodenervation being spastic paresis secondary to stroke.
The medical records of all patients undergoing ultrasound-guided intramuscular chemodenervation procedures performed between July 1, 2011, and October 16, 2015, were reviewed for demographic information, details regarding anticoagulation therapy, procedure specifics, and postinjection bleeding complications. All patients had a postinjection ultrasound to screen for hematoma.
Prevalence of clinically significant bleeding complications and of sonographically documented subclinical bleeding complications following ultrasound-guided chemodenervation procedures in patients on anticoagulation or antiplatelet therapy.
Of 328 procedures, only 2 subclinical hematomas were detected, resulting in a bleeding complication rate of 0.61% in this patient population. The target muscles in these cases were tibialis posterior and pronator teres, and both cases were in patients on anticoagulation therapy (as opposed to antiplatelet therapy).
The risk of clinically significant bleeding complication appears to be very small following ultrasound-guided intramuscular chemodenervation procedures in the setting of systemic anticoagulation or antiplatelet therapy.
IV.
接受抗凝或抗血小板治疗的患者在接受肌肉内化学神经阻断注射后可能有更高的出血并发症风险。肌肉骨骼超声可以通过提供血管结构的实时可视化和注射后监测来降低出血并发症的风险。在抗凝或抗血小板治疗的情况下，关于超声引导下肉毒毒素肌肉内化学神经阻断程序后出血并发症风险的有限数据存在。
提供在接受超声引导下肉毒毒素肌肉内化学神经阻断程序的抗凝或抗血小板治疗患者中出血并发症的初步结果数据。
回顾性病历回顾。
学术机构门诊痉挛诊所。
在 15 名患者（平均年龄 53.8 岁）中进行了总共 328 次超声引导下肌肉内肉毒毒素注射，化学神经阻断的主要指征是中风引起的痉挛性瘫痪。
回顾 2011 年 7 月 1 日至 2015 年 10 月 16 日期间进行的所有超声引导下肌肉内化学神经阻断程序的病历，以获取人口统计学信息、抗凝治疗细节、程序细节和注射后出血并发症信息。所有患者均接受注射后超声检查以筛查血肿。
在接受抗凝或抗血小板治疗的患者中，超声引导下化学神经阻断程序后临床显著出血并发症和超声记录下亚临床出血并发症的发生率。
在 328 例手术中，仅检测到 2 例亚临床血肿，导致该患者人群的出血并发症发生率为 0.61%。这些病例的目标肌肉为胫后肌和旋前圆肌，且均发生在接受抗凝治疗的患者（而非抗血小板治疗）中。
在全身抗凝或抗血小板治疗的情况下，超声引导下肌肉内化学神经阻断程序后临床显著出血并发症的风险似乎很小。
IV。
