Frequency of Hemorrhagic Side Effects of Botulinum Neurotoxin Treatment in Patients with Blepharospasm and Hemifacial Spasm on Antithrombotic Medication

Abstract

The aim of this study was to investigate the frequency of hemorrhagic side effects of botulinum neurotoxin A injections (BoNT/A) for the treatment of benign essential blepharospasm (BEB) and hemifacial spasm (HFS) in patients taking antithrombotic drugs (ATD). A total of 140 patients were included (female: 65%; BEB: 75%; mean age: 70 ± 12 years). According to their current antithrombotic medication, participants were either assigned to the ATD group (41%), or to the control group (59%). The ATD group was further divided into subgroups depending on the medication administered: acetylsalicylic acid, ADP receptor antagonists, direct oral anticoagulants, vitamin-K antagonists, or dual antiplatelet therapy. The frequency of hemorrhagic side effects was recorded by retrospective analysis of past treatments as documented in the patient’s file set in relation to the number of past treatments (hematoma frequency of past treatments, HFretro) as well as by a prospective survey capturing the side effects of one single treatment (hematoma frequency of actual treatment, HFactual). There was no significant difference in hematoma frequency between the ATD group and the control group, neither for past (HFretro: ATD: 2%; 45/2554; control: 4%; 109/2744) nor for the current BoNT/A treatments (HFactual: ATD: 30%; 16/53; control: 31%; 22/72). Even between ATD subgroups, hematoma frequency did not differ significantly. Overall, hemorrhagic side effects of the BoNT/A treatment for BEB and HFS were mild and non-disabling.

Postoperative ecchymoma of eyelid after botulinum toxin injection for hemifacial spasm: a case report

“…The intramuscular injections may cause various adverse effects including mild facial paresis, diplopia, allergy, pain, lid ptosis, brow ptosis, or hematomas. However, the available evidence suggests that hematoma at injection sites occur in less than 3% of BTXA injections ( 8 ) and no serious systemic side effects of the therapy have been reported yet ( 9 ).…”

Introduction to the Toxins Special Issue on Botulinum Toxins: New Uses in the Treatment of Diseases

“…In another contribution, Wenninger et al [ 10 ] analyzed the frequency of hemorrhagic side effects after BoNT/A injections, of different commercial preparations, for the treatment of benign essential blepharospasm and hemifacial spasm in patients taking antithrombotic drugs. The authors observed that, during the treatment of blepharospasm and hemifacial spasm with BoNT/A in patients undergoing concomitant treatment with antithrombotic drugs, the unwanted side effects, such as hematoma frequency, were not significantly different between patients treated with antithrombotic drugs or not.…”