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Meta-Analysis
. 2023 Feb;43(2):245-251.
doi: 10.1007/s00296-022-05232-y. Epub 2022 Nov 2.

Bleeding complications in patients on warfarin undergoing joint injection/aspiration: systematic review and meta-analysis

M Y Tarar  1 , R A Malik  2   3 , C P Charalambous  4   5
Affiliations
Meta-Analysis

Bleeding complications in patients on warfarin undergoing joint injection/aspiration: systematic review and meta-analysis

M Y Tarar et al. Rheumatol Int. 2023 Feb.

Abstract

Steroid injections in joints are commonly administered for the management of inflammatory or degenerative conditions. There is substantial controversy as to whether to continue warfarin when undertaking joint injection or aspiration. To assess the rate of bleeding complications in patients on warfarin undergoing joint injection/aspiration. Systematic review and meta-analysis. A literature search of 3 online databases was conducted by 2 reviewers using the Cochrane methodology for systematic reviews. Eligibility criteria were any study that reported bleeding complication rates in adult patients on warfarin undergoing a joint injection/aspiration whilst taking warfarin anticoagulation. Studies reporting on less than 5 patients were excluded. Meta-analysis was conducted using a random effects model. The search of databases resulted in a total of 1547 articles. After screening, 8 articles were deemed suitable for inclusion in the analysis, involving 871 injection/aspiration procedures. There were only 5 reported cases of bleeding. On meta-analysis the estimated bleeding complication rate was 1.5% (95% CI 0.5-4.5%). This meta-analysis shows that it is safe to perform joint injection and aspiration in patients on warfarin without routine prior testing of INR. Level of evidence: Level 4.

Keywords: Arthrocentesis; Bleeding; Intra-articular injection; Warfarin.

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Figures

Fig. 1
Fig. 1
Study methodology and selection criteria using PRISMA (preferred reporting items for systematic reviews and meta-analyses)
Fig. 2
Fig. 2
Meta-analysis of the included studies. Forrest plot showing estimated event rates and 95% CIs
Fig. 3
Fig. 3
Funnel plot distribution of included studies
See this image and copyright information in PMC

References

    1. Keavy R. The prevalence of musculoskeletal presentations in general practice: an epidemiological study. Br J Gen Pract. 2020;70(suppl 1):bjgp20X711497. doi: 10.3399/bjgp20X711497. - DOI - PubMed
    1. Liddell WG, Carmichael CR, McHugh NJ. Joint and soft tissue injections: a survey of general practitioners. Rheumatology (Oxford) 2005;44(8):1043–1046. doi: 10.1093/rheumatology/keh683. - DOI - PubMed
    1. Rodriguez-García SC, Castellanos-Moreira R, Uson J. Efficacy and safety of intra-articular therapies in rheumatic and musculoskeletal diseases: an overview of systematic reviews. RMD Open. 2021;7(2):e001658. doi: 10.1136/rmdopen-2021-001658. - DOI - PMC - PubMed
    1. Green L, Tan J, Morris JK, Alikhan R, Curry N, Everington T. A three-year prospective study of the presentation and clinical outcomes of major bleeding episodes associated with oral anticoagulant use in the UK (ORANGE study) Haematologica. 2018;103(4):738–745. doi: 10.3324/haematol.2017.182220. - DOI - PMC - PubMed
    1. Ouirke W, Cahill M, Perera K, Sargent J, Conway J. Warfarin prevalence, indications for use and haemorrhagic events. Ir Med J. 2007;100(3):402–404. - PubMed

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