A clinical quandary arises when doing joint aspirations and injections on patients who are on long-term oral anticoagulants. For a study, researchers sought to determine the safety of performing joint surgeries on these individuals in terms of bleeding risk. Furthermore, it is intended to determine what level of international normalized ratio (INR) is the safest for people getting vitamin K antagonists.

A medical literature review was carried out (electronic searches in Ovid [MEDLINE], EMBASE, and the Cochrane Library). Original English language papers published over the previous 10 years of patients getting joint injections or aspirations while on anticoagulant treatment were considered.

The inclusion criteria were satisfied by seven studies. Patients were being treated with a range of anticoagulants, including warfarin, acenocoumarol, and direct oral anticoagulants. About 4 incidences of bleeding were recorded after 5,427 surgeries across 9 sites during a 32-year span. The INR values for three instances with bleeding problems were 1.9, 2.3, and 3.4.

All studies found that joint injection is safe in anticoagulation individuals. Various joints and methods, anticoagulation reversal or withholding, and bridging with low molecular weight heparin did not appear to change bleeding risk. Bleeding problems were modest even among individuals with renal or hepatic impairment or those using concurrent antiplatelets.

In conclusion, joint aspiration and injection are safe in anticoagulant individuals. However, anticoagulation should not be stopped routinely in these individuals; choices should be taken individually. Because of the small number of events, a safe maximum INR value for joint surgeries cannot be determined.

Reference: journals.lww.com/jclinrheum/Abstract/2022/06000/The_Safety_of_Continued_Oral_Anticoagulation.8.aspx