Hand Corticosteroid Injections in Patients on "Blood Thinners"
Kristofer S. Matullo, MD; Ajith Malige, MD
St. Luke's University Hospital, Bethlehem, PA
Purpose: Our study aims to identify any influence that anti-coagulation and anti-platelet ("blood thinner") medications may have on corticosteroid injection complication rates (mainly hemarthrosis) placed in the hand.
Methods: Patients between the ages of 18 and 89 who received corticosteroid injections in the hand or wrist as anti-inflammatory therapy between 2013 and 2017 were included in this study. Patients medication at the time of injection were reviewed looking for the presence or absence of anti-coagulation and anti-platelet medications. Demographic characteristics, number of injections, complications, and eventual surgery rates were recorded for patients on "blood-thinners" and patients not on "blood-thinners."
Results: 502 patient charts were reviewed and included in this study, yielding 726 distinct diagnosis and 1473 placed injections. Of the 726 different diagnoses treated, only 152 (20.9%) needed eventual surgical intervention. Of the 12 instances of adverse reactions in the 1473 injections placed (2.5%), 7 complaints of increased pain (0.5%), 4 complaints of swelling and erythema (0.3%), 3 complaints consistent with contact dermatitis (0.2%), and 0 instances of hemarthrosis were noted (0.0%). Of the 433 injections placed in patients on "blood thinners," 6 (1.4%) complications were documented post-procedure (2 complications out of 50 in anti-coagulation, 4 complications out of 371 in anti-platelet, and 0 complications out of 12 in cohort on both medications). This was shown to be statistically equivocal to the 6 (0.6%) complications after 1040 injections placed in patients not on "blood thinners" (p=0.06).
Conclusions: Given the low rate of complications in patients on "blood thinners" versus those not on "blood thinners" as well as the high success rate of avoiding surgery, the authors believe that corticosteroid injections are a safe and efficacious treatment adjuvant to patients without the need to stop "blood thinner" medications.
Level of Evidence: Diagnostic Level III
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