Educational Update European School of Prolotherapy (ESP)and Societa Italiana di Proloterapia: Septem

Knee Injection on Coumadin and Plavix Patients

Many questions and debates were taken in for these patients. For many doctors doing injection therapy they seemed to be worried and concerned on suspending anticoagulant therapy?

Question: September 2016

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.

Here are some updated answers!!!

Physician answered in the forum : 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.

This Physician answered in the forum:

5,209 procedures performed on patients without stopping anticoagulant/antiplatelet therapy showed no detectable signs of hemorrhagic or complications

Dr. Cavallino Stephen – Director of the European School of Prolotherapy and the Vice President of the Società Italiana di Proloterapia (SIPRO) “I agree with my colleagues that there is so much information that we are SAFE doing injectiontherapy in these particular patients. I have been doing Injection Therapy (Prolotherapy) for over 15 years without any complications in patients taking anticoagulants drugs. “For years I had them suspended their anticoagulant therapy for 2 days before treatment but because I did my research and changed my understandings about complications in these patients, today, I treat these patients without suspension of their anticoagulant therapy. I have found that if they do have some sort of hematoma, I am not worried at all because we all know that platelets release growth factors helping our regeneration therapy. My recommendation is that we do only the necessary injections and use less traumatic needles in the procedure of Prolotherapy in these patients.