Knee Injection on Anticoagulants

[theanswer03]

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What are your thoughts on doing an intra articular knee injection on a patient on Coumadin and plavix concurrently. The patient's INR is on the low therapeutic range. I've found a lot of evidence that says its safe to do joint injections on coumadin, if the patient's INR is therapeutic, but couldn't find anything specifically about coumadin and plavix together. Also - what about aspirin and plavix? Any sources/references/practical advice would be appreciated. Thanks.

 

[massmocha]

Probably safe, but definitely surgeon dependent. If your goal is intra-articular injection to treat arthritic pain, probably risk outweighs benefit because you don't want to leave the patient with a hemarthrosis. If you are trying to rule out a septic knee, probably go for it anyway, just try not to have a traumatic tap.