Research Centre for Health Professions, University of Brighton, Eastbourne, UK.
East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, UK.
Musculoskeletal Care. 2023 Sep;21(3):702-712. doi: 10.1002/msc.1743. Epub 2023 Feb 18.
Corticosteroid 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).
To investigate peri-procedural management and bleeding complications following musculoskeletal injections or aspirations with anti-thrombotic medication use.
A 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.
Of 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.
In 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.
皮质类固醇注射和抽吸是治疗肌肉骨骼和炎症性疾病的常见干预措施。然而，对于正在使用抗血栓药物的患者，特别是对于直接口服抗凝剂（DOAC），支持注射决策和围手术期管理的安全性证据仍然有限。
调查在使用抗血栓药物的情况下进行肌肉骨骼注射或抽吸的围手术期管理和出血并发症。
这是一项在英国两家大型医疗机构的骨科、风湿病科和放射科进行的前瞻性观察研究（2018 年 10 月至 2020 年 12 月）。数据收集包括每周确定肌肉骨骼手术、30 天内急诊就诊或入院情况，以及在术后 2 周内发送的随访问卷。使用描述性统计分析抗栓/抗血小板药物使用、围手术期管理和出血并发症。
在 5080 例手术中，1338 例中有 237 例报告了抗血栓药物的使用：华法林（n=36）、DOAC（n=75）和抗血小板药物（n=126）。没有自我报告或电子识别出临床显著出血事件/并发症。仅报告了局部瘀斑（使用组为 8.6%，未使用组为 0.2%），且仅在继续用药或国际标准化比值（INR）水平≥3.8 或未知时出现。仅中断了 72 例 DOAC 使用中的 3 例。
在这项研究中，没有报告或发现肌肉骨骼注射或抽吸后出现临床显著的出血事件或并发症，仅报告了局部瘀斑。并非普遍惯例是检查 INR 水平，且 DOAC 中断也不常见。这些发现增加了证据表明，在继续使用抗血栓药物和 INR 水平处于较低目标范围时，肌肉骨骼手术似乎是出血并发症风险较低的手术。关于关节内或软组织医源性后果的研究将增加风险/获益评估。
