Background The introduction of new oral anticoagulants provides us with a new therapeutic intervention and secondary prevention opportunity in stroke patients previously not well controlled with acenocumarol due to not compliance or other issues.
As with other anticoagulants or even antiplatelet agents, the attending doctor may hesitate to perform a joint puncture in patients receiving such treatments.
Objectives The purpose of this study is to describe the four-year cumulative experience of joint and peri-articular punctures in patients receiving Dabigatran, a new oral anticoagulant recently introduced in our country.
Methods We performed a systematic review of the records of patients who underwent a knee joint aspiration or periarticular shoulder joint puncture for diagnostic or therapeutic purposes and who were under treatment with dabigatran between the years 2012 and 2016.
For this purpose we conducted an search for electronic records within that period, using the search terms: “infiltration”, “arthrocentesis” or “joint puncture” and “shoulder” or “knee” and “dabigatran” or it's brand names.
Follow up visits in either primary care (HORUS® Application) or emergency settings (CAJAL® Application) were analyzed, regardless of the main complain at admission, and the data was collected from this records.
Results Between 2012 and 2016, 68 joint knee punctures and 49 periarticular shoulder punctures were performed in dabigatran patients. Of the 117 procedures, 78 (66.6%) were performed by attending physicians in Traumatology, Rheumatology or Physical Medicine and Rehabilitation, and the rest by internal medicine residents.
Of the 68 knee arthrocentesis, in 48 (70.5%) of the cases synovial fluid collection and infiltration were performed, while in the rest only infiltration was needed.
Of the 49 shoulder punctures, in 12 (24.4%) a bursocentesis was performed while in the rest only an infiltration was done.
16 knee and 17 shoulder punctures (23.5% and 34.6%) were ultrasound assisted procedures.
Among the patients with knee puncture, 11 (16.1%) came back before 15 days due to procedure related symptoms. Of these, 9 did so because of persistence of the main symptom or persistent pain and 2 because of increased pain. These two patients were studied sonographically and one of them had a hemarthrosis that was treated conservatively.
In the group of patients with shoulder puncture, 7 (14.2%) came back before the first 15 days and in all of them the cause was persistence of the main symptom. None of the patients required admission at the hospital. None of the patients with ecography-assisted procedures came back before the first 15 days.
No patient consulted due to bleeding after the first fifteen days. (There were no hemarthrosis cases after the fists 15 days). The outcome of the procedure was not influenced by the person performing it (attending vs resident), however, all the echocardiographic procedures were performed by an attending.
Conclusions Although it is a small population, this is to the best of our knowledge, the biggest published serie of dabigatran anticoagulated patients who underwent a large joint or periarticular puncture. We can conclude that this type of punctures are safe in patients with this characteristics. On the other hand, there is evidence that ecography-assisted procedures are more effective in this group of patients.
Disclosure of Interest None declared