Hand and wrist surgery without suspending warfarin or oral antiplatelet – systematic review

Abstract

To assess, through a systematic literature review, whether or not it is necessary to suspend antithrombotic medications (warfarin, aspirin, and clopidogrel) to perform elective wrist and hand surgeries. The search for articles was performed using a combination of keywords in the databases available, without scientific design constraints, being selected series with five or more surgeries; the selected articles were analyzed regarding serious (need for surgical treatment) and mild complications (without surgery). Seven articles were retrieved and analyzed; 410 wrist and hand surgeries were performed in patients on warfarin or aspirin and clopidogrel, with three serious complications (0.7%) and 38 mild (9.2%); 2023 surgeries were performed in patients without use of antithrombotics, with zero serious and 18 (0.8%) minor complications. Patients using warfarin or oral antiplatelet (aspirin, clopidogrel, and aspirin associated with clopidogrel) need not suspend the medication to undergo wrist and hand surgery.

The Safety of Continued Oral Anticoagulation Therapy in Joint Injections and Aspirations

“…Interestingly, a wider review of the literature demonstrated that arthrograms, 7 hand and wrist surgery 19 for Dupuytren's contracture, and carpal tunnel decompression can all be safely carried out without alteration to the anticoagulation regimen 20 …”

The Risk of Complications after Carpal Tunnel Release in Patients Taking Acetylsalicylic Acid as Platelet Inhibition: A Multicenter Propensity Score–Matched Study

“…The observed complication rate of 8.8 percent is comparable to the recent literature. 4 Strikingly, this study shows in a large population of almost 500 patients and over 600 performed carpal tunnel release procedures that open carpal tunnel release with a minimally invasive short incision in patients under platelet inhibitor therapy is safe and can be performed without interruption. It further provides evidence from multivariate, adjusted analyses on significant independent risk factors for impaired outcome.…”

“…6,7,13 A review from Sardenberg and colleagues published in 2017 shows that there are only four studies available on the relevance of platelet inhibitors in hand surgery. 4 All these studies lack risk adjustment to possible confounders, in contrast to the current study.…”

“…Nevertheless, there are good data from an evidence level II study available and the clinical notion of experienced hand surgeons that there is no necessity to interrupt antiplatelet medication, although evidence from large randomized studies is still scarce and there are no risk-adjusted data available yet. [3][4][5] It can be hypothesized that the repercussions of interrupting platelet aggregation inhibition, such as thrombotic events, are more likely to occur than surgical complications after surgery under antiplatelet medications. Moreover, these repercussions appear to be much more serious (e.g., stroke, myocardial infarction) than the possible consequences of hemorrhagic complications (e.g., hematoma, postoperative bleeding).…”

Perioperative Management of Oral Anticoagulants and Antiplatelet Therapy in Hand and Wrist Surgery

“…Since the related complication rate (bleeding and bruising events) was low and the studies included were of low evidence, individually tailored management was recommended with the patient and the medical treatment team. In their systematic review of the literature, Sardenberg, et al 17 concluded that patients undergoing elective hand and wrist surgery do not need to stop warfarin, aspirin, clopidogrel, or aspirin with clopidogrel. We reviewed 13 available primary sources and relevant trials.…”