Key result
Joint injection and aspiration in patients on warfarin is safe, with a very low estimated bleeding complication rate of 1.5%.
Why the study?
There is substantial controversy regarding whether to continue warfarin during joint injection or aspiration, prompting an assessment of bleeding complication rates.
Does joint injection or aspiration cause bleeding complications in adult patients continuing warfarin therapy?
Meta-Analysis (n=871)
Does joint injection or aspiration cause bleeding complications in adult patients continuing warfarin therapy?
Effect estimate: 1.5% (95% CI 0.5-4.5)
Joint injection and aspiration can be safely performed in patients on warfarin without routine prior testing of INR, given the very low estimated bleeding complication rate of 1.5%.
Supports joint injection/aspiration on warfarin without routine INR testing; confirms low bleeding risk via meta-analysis.
Steroid injections in joints are commonly administered for the management of inflammatory or degenerative conditions. There is substantial controversy as to whether to continue warfarin when undertaking joint injection or aspiration. To assess the rate of bleeding complications in patients on warfarin undergoing joint injection/aspiration. Systematic review and meta-analysis. A literature search of 3 online databases was conducted by 2 reviewers using the Cochrane methodology for systematic reviews. Eligibility criteria were any study that reported bleeding complication rates in adult patients on warfarin undergoing a joint injection/aspiration whilst taking warfarin anticoagulation. Studies reporting on less than 5 patients were excluded. Meta-analysis was conducted using a random effects model. The search of databases resulted in a total of 1547 articles. After screening, 8 articles were deemed suitable for inclusion in the analysis, involving 871 injection/aspiration procedures. There were only 5 reported cases of bleeding. On meta-analysis the estimated bleeding complication rate was 1.5% (95% CI 0.5-4.5%). This meta-analysis shows that it is safe to perform joint injection and aspiration in patients on warfarin without routine prior testing of INR. Level of evidence: Level 4.
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Tarar et al. (2022) conducted a meta-analysis in Musculoskeletal conditions requiring joint injection or aspiration (n=871). Joint injection or aspiration was evaluated on Bleeding complication rate (1.5%, 95% CI 0.5-4.5). Joint injection and aspiration in patients on warfarin is safe, with a very low estimated bleeding complication rate of 1.5%.
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