Antithrombotic Agents May Be Safely Continued in Wide-Awake Carpal Tunnel Release
Sarah E. Sasor, MD; Tyler A. Evans, MD; Julia A. Cook, MD; Peter J. Nicksic, BA; Elizabeth A. Lucich, MD; William A. Wooden, MD; Sunil S. Tholpady, MD PhD; Michael W. Chu, MD
Indiana University, Indianapolis, IN
Many patients requiring carpal tunnel release (CTR) are on long-term antithrombotic agents (AT) for various indications. This presents a challenge for hand surgeons who must weigh the risk of bleeding if AT is continued against the risk of thrombosis if AT is temporarily stopped. The goal is this study is to evaluate the safety of continuing antithrombotics in the perioperative period in wide-awake, open CTR.
All wide-awake CTR's performed at a single institution from February 2013-April 2016 were retrospectively reviewed. Patients were anesthetized with 1% lidocaine with 1:100,000 epinephrine. A standard, open approach with a longitudinal palmar incision was used in all cases. Demographics, electromyography, tourniquet use, operative time, estimated blood loss (EBL), complications, and outcomes were evaluated. Patients who remained on AT agents through surgery were analyzed separately. Statistical analysis was performed using the Student's t-test and Fisher's exact test in SPSS (SPSS Inc., Chicago IL).
304 CTR's were performed on 246 patients during the study period. Ninety-three patients (30.6%) were on AT agents. There were 69 patients on aspirin only, 7 on warfarin, 9 on clopidogrel, 1 on dabigatran, 3 on warfarin and aspirin, and 4 on dual antiplatelet therapy. AT patients were more likely to be older (mean age 66.1 vs. 56.9 years, p<0.001), male (96.8% vs. 84.4%, p=0.002), diabetic (55.9% vs. 22.9%, p<0.001) non-smokers (82.8% vs. 71.7%, p=0.04). Average pre-operative median nerve motor latencies at the wrist and rate of intra-operative tourniquet use were similar between groups.
A forearm tourniquet was used in 34.4% of CTR's on AT patients and 27.3% of non-AT patients. There was no statistical difference in EBL (3.94 vs. 3.89mL, p = 0.87) or operative time (22.04 vs. 22.99 minutes, p = 0.38) when comparing AT vs. non-AT patients, respectively.
Rates of post-operative complications were similar between groups (5.4% AT vs 4.9% non-AT, p=1.0). No hematomas or neurological complications were reported and no patients required re-operation during the study period. Overall, 91.8% of patients reported improvement symptoms post-operatively with a mean follow-up time of 3.3 months
Cessation of antithrombotic agents in the perioperative period is common in elective hand surgery. This study provides evidence that antithrombotics may be safely continued in wide-awake carpal tunnel release - with or without a tourniquet.
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