Letter to the Editor
Safety of Joint Puncture in Patients Receiving Anticoagulant Therapy With Dabigatran
Seguridad de la punción articular en pacientes en tratamiento anticoagulante con dabigatrán
Carlos Antonio Guillén Astete
, María Terán Tinedo, José Renato Quiñones Torres, Mónica Luque Alarcón, Alina Boteanu
Corresponding author
Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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The mean age of the patients at the time of the intervention was 71 years (standard deviation: 3) and the proportion of women was 47.8%. Dabigatran users were considered to be those being treated with the drug for at least 1 month. Of the 117 procedures, 78 (66.6%) were carried out by specialists in orthopedics, rheumatology or physical medicine and rehabilitation, and the rest by residents. Of the 68 intra-articular interventions performed in knees, 48 (70.5%) involved arthrocentesis of the synovial fluid as well as injection, whereas, in the remainder, the treatment consisted of the injection alone. In the 49 procedures involving the shoulder, fluid was collected from the bursa in 12 cases (24.4%) and the remainder of the procedures involved only the injection. Ultrasound guidance was utilized in 16 injections in the knee and 17 in the shoulder (23.5% and 34.6%, respectively). The follow-up of the course of the patients who underwent the interventions was done using the Horus<span class="elsevierStyleSup">®</span> system, the follow-up chart of the rheumatological and musculoskeletal unit of the emergency department (RMSED) and/or the registry of visits to the emergency department of our hospital. Of all the patients who were treated with intra-articular injection of the knee, 11 (16.1%) consulted within the first 15 days in relation to the procedure they had undergone. Of these, 9 of them came because of the persistence of the major symptom or discomfort and 2 because of an increase in the pain. Both patients underwent ultrasound and 1 of them had a conservatively treated hemarthrosis. Of the 49 patients whose intervention involved the shoulder, 7 (14.2%) consulted during the first 15 days. The reason in every case was persistence of the symptom. None of the patients were hospitalized. None of the patients in whom ultrasound guidance had been employed consulted within the first 15 days. No patient consulted because of bleeding after the first 15 days. The performance of the treatment by a specialist or a resident did not significantly influence the results of the procedure; however, all of the ultrasound-guided procedures were carried out by a rheumatology specialist.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Judging by our latest results, intra-articular injection of the knee and periarticular injection of the shoulder in patients receiving anticoagulant therapy with dabigatran seems to be comparatively safe as compared to treatment with acenocoumarol. As is well known, the study of the synovial fluid is fundamental for making decisions in cases of acute monoarthritis, and delaying needle aspiration for any reason—such as a history of anticoagulation—contributes to an increase in the risk of irreversible or even fatal joint lesions when the suspected diagnosis is infectious arthritis.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our recent results, plus those previously obtained in patients taking acenocoumarol and others confirmed for warfarin, underline the fact that the condition of anticoagulation should not be an impediment or justification for delaying diagnostic or therapeutic intra-articular or periarticular injection.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guillén Astete CA, Terán Tinedo M, Quiñones Torres JR, Luque Alarcón M, Boteanu A. Seguridad de la punción articular en pacientes en tratamiento anticoagulante con dabigatrán. Reumatol Clin. 2017;13:368–369.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is it safe to perform joint infiltrations or aspirations in patients anticoagulated with acenocoumarol?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Guillen Astete" 1 => "A. Boteanu" 2 => "C. Medina Quiñones" 3 => "N. Garcia Montes" 4 => "F. Roldan Moll" 5 => "C. 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