抗凝在接受常规肌肉骨骼介入治疗的患者中很常见。先前的回顾性研究已经确定了在进行此类干预时，使用新型口服抗凝剂（NOAC）持续抗凝的安全性。的确,超声（美国）引导的介入操作显示出比盲目解剖操作更好的安全性。前瞻性评估NOAC抗凝患者接受介入关节或关节周围手术的围手术期出血事件。前瞻性招募了连续诊断为需要介入治疗的炎性或退行性风湿病病理的患者。第1组接受NOAC治疗，第2组接受维生素K拮抗剂治疗，第3组未抗凝。在国际演习之前，持续给予NOAC治疗，在基础抗凝适应症决定的方案中。人口统计,合并症,实验室参数,局部给药（皮质类固醇或粘胶补充剂），介入机动位置，针头尺寸,并记录局部出血事件.术后控制在30分钟进行，48h,和7天。接受NOAC治疗的患者未发生关节/关节周围出血事件，不管它们的类型和剂量，局部用药,针头尺寸,location,以及每个人的干预次数。所有组中的几名患者在注射部位均出现小的浅表瘀斑。我们的结果表明，在美国指导的注射之前，NOAC在连续方案中是安全的。甚至作为双重抗血栓治疗（与阿司匹林联合使用）。使用较低规格的针头，选择用于粘性补充疗法，对程序结果没有不良影响。要点•目前，在进行常规关节内或关节周围介入操作时,没有进行前瞻性研究来确定持续NOAC抗凝的安全性.•该研究提供了广泛的关节内和关节周围介入操作，包括以前未评估的解剖目标和针头大小。•该研究提供了在同一患者中进行重复操作的观点，在很短的时间和更长的时间间隔。•在我们的研究中观察到的零围手术期出血风险可以使从业者放心，并表明US指导的介入治疗干预对于接受不同NOAC连续方案治疗的患者是安全的。
Anticoagulation is common in patients undergoing routine musculoskeletal interventional maneuvers. Previous retrospective studies have established the safety of continuing anticoagulation with novel oral anticoagulants (NOACs) when performing this kind of interventions. Indeed, ultrasound (US)-guided interventional maneuvers have shown a superior safety profile compared to blind anatomical maneuvers. To evaluate prospectively the periprocedural bleeding events in NOAC-anticoagulated patients undergoing interventional articular or
periarticular procedures. Consecutive patients diagnosed with inflammatory or degenerative rheumatologic pathology requiring interventional maneuvers were prospectively recruited. Group 1 was treated with NOACs, group 2 was treated with vitamin K antagonists, and group 3 was not anticoagulated. Prior to the international maneuver, NOAC therapy was continuously administered, in regimens dictated by the underlying anticoagulation indication. Demographics, comorbidities, laboratory parameters, locally administered medication (corticosteroids or viscosupplementation), interventional maneuver location, needle size, and local bleeding events were recorded. Post-procedural control was performed at 30 min, 48 h, and 7 days. No articular/
periarticular bleeding event occurred in patients treated with NOACs, regardless of their type and dosage, locally administered medication, needle size, location, and number of interventions per individual. Several patients in all groups developed small superficial ecchymoses at the injection site. Our results suggest that NOACs are safe to be used in a continuous regimen prior to US-guided injections, even as dual antithrombotic therapy (in combination with aspirin). The use of lower gauge needles, chosen for viscosupplementation therapy, was not burdened with adverse effects on the procedural outcome. Key Points • Currently, no prospective studies have been performed to establish the safety of continuous NOAC anticoagulation when performing routine intra- or periarticular interventional maneuvers. • The
study offers an extensive view on a wide spectrum of intra- and
periarticular interventional maneuvers including anatomic targets and needle sizes that were not previously assessed. • The
study offers a perspective into performing repetitive maneuvers in the same patient, both over a short time and at longer intervals. • The zero periprocedural bleeding risk observed in our
study may reassure practitioners and suggest that US-guided interventional therapeutic interventions are safe in patients treated with a continuous regimen of different NOACs.
