Association of aspirin and other non-steroidal anti-inflammatory drugs with bleeding complications in image-guided musculoskeletal biopsies

Rilland, Eddy Zandee van; Stanley, Kim; Mhuircheartaigh, Jennifer Ní; Shif, Yuri; Kung, Justin W.; Wu, Jim S.

doi:10.1007/s00256-020-03510-z

Cited by 3 publications

(3 citation statements)

References 28 publications

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“…Interrupting these medications for musculoskeletal procedures has not been advocated in guidance, however this is based on limited evidence (Kaye et al., 2019; Patel et al., 2019). Research on biopsy procedures (Metha et al., 2019; Zandee van Rilland et al., 2020) and pain intervention settings suggested there was no need to stop NSAIDS and low dose aspirin, and limited evidence to continue clopidogrel and prasugrely, to avoid thromboembolic risks, but based on paucity of literature. The current study adds support that continuing antiplatelet medications with musculoskeletal procedures appears to have little risk of a clinically significant bleeding complication.…”

Section: Discussionmentioning

confidence: 99%

“…For antiplatelet medications, research on aspirin and non‐steroidal anti‐inflammatory drug (NSAID) bleeding risk with musculoskeletal procedures is limited and inconclusive (Patel et al., 2019; Zandee et al., 2020). However, guidance on peri‐procedural management in radiology and pain interventions have recommended that antiplatelet medications can be continued, with greater consideration given to dual antiplatelet therapy (Atwell et al., 2017; Patel et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

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Peri‐procedural management and incidence of bleeding events following musculoskeletal injections or aspirations in people on oral anticoagulation and antiplatelet therapy

McCrum

Furner

Grainger

2023

Musculoskeletal Care

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BackgroundCorticosteroid injections and aspirations are common interventions for managing musculoskeletal and inflammatory conditions. However, there remains limited safety evidence to support injection decisions and peri‐procedural management in people on anti‐thrombotics, particularly for direct oral anticoagulants (DOACs).ObjectivesTo investigate peri‐procedural management and bleeding complications following musculoskeletal injections or aspirations with anti‐thrombotic medication use.DesignA prospective observational study was undertaken (October 2018–December 2020) in Orthopaedics, Rheumatology and Radiology specialities in two large UK healthcare providers. Data collection involved weekly identification of musculoskeletal procedures, emergency attendance or admission within 30 days and follow‐up questionnaires sent within 2 weeks post‐procedure. Descriptive statistics were used to analyse anticoagulant/anti‐platelet use, peri‐procedural management and bleeding complications.ResultsOf 5080 procedures, 237 of 1338 responses reported antithrombotic use: warfarin (n = 36), DOACs (n = 75) and antiplatelets (n = 126). There were no self‐report or electronic identification of clinically significant bleeding events/complications. Only local bruising was reported (8.6% vs. 0.2% with non‐use), and only with medication continuation or international normalised ratio (INR) levels ≥3.8 or unknown. Only 3/72 DOAC use was interrupted.ConclusionsIn this study, no clinically significant bleeding events or complications were reported or identified following musculoskeletal injections or aspirations, with only localised bruising reported. It was not universal practice to check INR levels and DOAC interruption was uncommon. Findings add evidence that musculoskeletal procedures appear to be low risk procedures for bleeding complications with antithrombotic continuation and when INR levels within lower target range. Research on intra‐articular or soft tissue iatrogenic consequences would add to risk/benefit evaluations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Peri‐procedural management and incidence of bleeding events following musculoskeletal injections or aspirations in people on oral anticoagulation and antiplatelet therapy

McCrum

Furner

Grainger

2023

Musculoskeletal Care

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“…A recent study by Zandee van Rilland et al showed a similar low risk of bleeding during CNB in groups of patients who stopped taking aspirin and/or NSAIDS and those who did not stop taking aspirin and/or NSAIDS (2.3% versus 1.7%, respectively). 26 An article by Shif et al in 2018 compared groups of patients who underwent preprocedure coagulation testing (INR and platelets) with a group of patients in whom preprocedure coagulation testing was omitted, showing a bleeding complication rate of 2.6% and 1.1%, respectively. They concluded that preprocedure coagulation tests can safely be omitted in most patients undergoing soft tissue and bone CNB due to the low risk of bleeding.…”

Section: Preprocedural Planning and Biopsy Techniquementioning

confidence: 99%

Concepts in Musculoskeletal Bone and Soft Tissue Biopsy

Mills

Leake

Crawford

et al. 2021

Semin Musculoskelet Radiol

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Imaging-guided needle biopsy of musculoskeletal lesions is a high-yield and low-risk procedure that can be used for definitive characterization of indeterminate bone and soft tissue lesions. Familiarity with the preprocedural, technical, and postprocedural steps is vital for the appropriate management of these cases. Biopsy request triage requires an awareness of definitively benign conditions and other tumor mimics. A complete clinical, laboratory, and imaging work-up is essential for procedural planning and determining pathologic concordance. Consultation with an orthopaedic oncologist is a requisite step to ensure maximizing biopsy yield and to avoid interference with any future limb-sparing surgical intervention. Knowledge of the equipment, pertinent medications, and appropriate biopsy technique can minimize the risk of periprocedural complications. Finally, the radiologist may be required to discuss the concordance of histopathology with preprocedure imaging, perform repeat image-guided biopsy, and carefully interpret sarcoma surveillance imaging examinations.

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Troubleshooting Challenging Musculoskeletal Tumor Biopsies: Tricks of the Trade

Zandee

Deshmukh

2022

Seminars in Roentgenology

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Association of aspirin and other non-steroidal anti-inflammatory drugs with bleeding complications in image-guided musculoskeletal biopsies

Cited by 3 publications

References 28 publications

Peri‐procedural management and incidence of bleeding events following musculoskeletal injections or aspirations in people on oral anticoagulation and antiplatelet therapy

Peri‐procedural management and incidence of bleeding events following musculoskeletal injections or aspirations in people on oral anticoagulation and antiplatelet therapy

Concepts in Musculoskeletal Bone and Soft Tissue Biopsy

Troubleshooting Challenging Musculoskeletal Tumor Biopsies: Tricks of the Trade

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