Knee Injection on Coumadin AND Plavix

[theanswer03]

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. Any sources/references/practical advice would be appreciated. Thanks.

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[PMR2008]

I routinely perform peripheral joint injections on patients on anti coagulants but I will use thinner needles (27 guage vs 25 or lower). The risk is higher for them to develop a blot clot, MI and have a stroke vs intra articular bleed.
http://www.ncbi.nlm.nih.gov/pubmed/23925554
http://www.ncbi.nlm.nih.gov/pubmed/22340924
Not sure of any studies with patients on both Coumadin and Plavix but I would still not stop them.

 

[lobelsteve]

I was expert on a case of man who passed while holding plavix for hip injection. I believe stopping anticoagulation and antiplatelet for joints is a never event. We now have enough data to continue these agents with epidural injections.

 

[SSdoc33]

I was expert on a case of man who passed while holding plavix for hip injection. I believe stopping anticoagulation and antiplatelet for joints is a never event. We now have enough data to continue these agents with epidural injections.

no, we dont.

but i agree, you are fine to continue them for a joint injection.

 

[lobelsteve]

no, we dont.

but i agree, you are fine to continue them for a joint injection.

doi:10.1093/pm/pnw108

Summary

• 5,209 procedures performed on patients without stopping anticoagulant/antiplatelet therapy showed

no

detectable

signs

of

hemorrhagic

complicaLons

 

[SSdoc33]

doi:10.1093/pm/pnw108

Summary

• 5,209 procedures performed on patients without stopping anticoagulant/antiplatelet therapy showed

no

detectable

signs

of

hemorrhagic

complicaLons

well, there you have it. incontrovertible evidence.

id love to be able to keep these patients on blood thinners. you sort of need some concensus statement from some society, no?

 

[lobelsteve]

Pending from SIS.

 

[oreosandsake]

agree with the above. but important to consider the reason why they are on coumadin... A fib with history of stroke is very different than below the knee DVT from hospitalization 5 months ago. I have seen people ask cards/heme to sign off on holding AC. heard of a patient who got bad MCA infarct after AC was held for epidural. sad story.

 

[oreosandsake]

Pending from SIS.

wow, seriously?

 

[theanswer03]

Any issues with an intra articular injection on someone on dialysis?

 

[lobelsteve]

Yeah, dialysis centers smell icky.

 

[theanswer03]

Yeah, dialysis centers smell icky.

Haha .. what about when the patient returns from dialysis and is in your office..

 

[lobelsteve]

Needle goes in.