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Padda I, Fabian D, Sebastian SA, Reyes N, Fulton M, Martinez D, Mahtani A, Sethi Y, Johal G. Spontaneous atraumatic heparin-induced hemarthrosis in a patient treated for non-ST-elevation myocardial infarction. Radiol Case Rep 2023; 18:1596-1600. [PMID: 36852288 PMCID: PMC9958252 DOI: 10.1016/j.radcr.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 02/16/2023] Open
Abstract
Hemarthrosis secondary to heparin use is a scarce event, especially in patients with no underlying thrombophilia or platelet disorders. Although previously associated with thrombophilia, platelet disorders, or secondary to fibrinolytic therapy, to date, there are very few reported cases in contemporary literature for heparin-induced hemarthrosis. In this article, we report a case of left shoulder joint inferior subluxation secondary to heparin-induced hemarthrosis in an 81-year-old male with an extensive cardiac history and multiple comorbidities. This case report depicts a rare event and discusses its clinical implications aiding healthcare professionals in an early diagnosis and timely management.
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Affiliation(s)
- Inderbir Padda
- Richmond University Medical Center, Staten Island, NY, USA
| | - Daniel Fabian
- Richmond University Medical Center, Staten Island, NY, USA
| | | | - Nicholas Reyes
- Richmond University Medical Center, Staten Island, NY, USA
| | - Matthew Fulton
- Richmond University Medical Center, Staten Island, NY, USA
| | | | - Arun Mahtani
- Richmond University Medical Center, Staten Island, NY, USA
| | - Yashendra Sethi
- Government Doon Medical College, Dehradun, Uttarakhand, India,PearResearch, Dehradun, Uttarakhand, India
| | - Gurpreet Johal
- University of Washington, Valley Medical Center, 400 S 43rd St, Renton, Seattle, WA 98055, USA,Corresponding author.
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Dalrymple J, Davies A, Biggs A, Rajcoomar S, Gill I. Management of Haemarthrosis in Patients On Oral Anticoagulants. Geriatr Orthop Surg Rehabil 2022; 13:21514593221076966. [PMID: 35573907 PMCID: PMC9102153 DOI: 10.1177/21514593221076966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/01/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Aims Our aim was to investigate the management of patients who were admitted to hospital with an acute haemarthrosis whilst taking oral anticoagulants, and highlight the outcomes of different management strategies. Methods A retrospective review was performed of all orthopaedic admissions over a 42-month period (January 2015–July 2018) to the Orthopaedic Department of a London District General Hospital. All patients admitted with a spontaneous joint haemarthrosis and concomitant use of oral anticoagulants was identified. Anonymised data was placed on a secure trust database. Findings A total of 31 patients were included. 22 patients (71%) had their anticoagulant temporarily held during admission. 9 patients (32%) had their anticoagulation reversed with 10 mg of vitamin K. 5 patients had their haemarthrosis aspirated either on admission or during their hospital stay. The overall mean length of stay in patients with a haemarthrosis was 7.0 days. The mean length of stay in patients who had their anticoagulation held was 8.6 days. In contrast, patients who continued taking their anticoagulation were found to have an average length of stay of 2.3 days. No patients suffered a thrombotic event in the 60 days following discharge. No adverse events were recorded following joint aspiration. Conclusion There is currently no consensus on the management of haemarthrosis in patients on oral anticoagulants. Continuing the anticoagulants did not increase length of hospital stay. Further research may focus on assessing the effect of management adjuncts on patient outcomes and their cost effectiveness to aid the development of local and/or national guidelines.
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Affiliation(s)
- James Dalrymple
- Department of Trauma and Orthopaedics, University College London Hospital, London, UK
| | - Andrew Davies
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London, London, UK
| | - Alexandra Biggs
- Department of Trauma and Orthopaedics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Shahil Rajcoomar
- Department of Trauma and Orthopaedics, Kingston Hospital NHS Foundation Trust, Kingston, UK
| | - Ian Gill
- Department of Trauma and Orthopaedics, Kingston Hospital NHS Foundation Trust, Kingston, UK
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3
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Gallo K, Goede A, Eckert A, Moahamed B, Preissner R, Gohlke BO. PROMISCUOUS 2.0: a resource for drug-repositioning. Nucleic Acids Res 2021; 49:D1373-D1380. [PMID: 33196798 PMCID: PMC7779026 DOI: 10.1093/nar/gkaa1061] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 01/21/2023] Open
Abstract
The development of new drugs for diseases is a time-consuming, costly and risky process. In recent years, many drugs could be approved for other indications. This repurposing process allows to effectively reduce development costs, time and, ultimately, save patients’ lives. During the ongoing COVID-19 pandemic, drug repositioning has gained widespread attention as a fast opportunity to find potential treatments against the newly emerging disease. In order to expand this field to researchers with varying levels of experience, we made an effort to open it to all users (meaning novices as well as experts in cheminformatics) by significantly improving the entry-level user experience. The browsing functionality can be used as a global entry point to collect further information with regards to small molecules (∼1 million), side-effects (∼110 000) or drug-target interactions (∼3 million). The drug-repositioning tab for small molecules will also suggest possible drug-repositioning opportunities to the user by using structural similarity measurements for small molecules using two different approaches. Additionally, using information from the Promiscuous 2.0 Database, lists of candidate drugs for given indications were precomputed, including a section dedicated to potential treatments for COVID-19. All the information is interconnected by a dynamic network-based visualization to identify new indications for available compounds. Promiscuous 2.0 is unique in its functionality and is publicly available at http://bioinformatics.charite.de/promiscuous2.
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Affiliation(s)
- Kathleen Gallo
- Charité Universitaetsmedizin Berlin, Institute of Physiology, Structural Bioinformatics Group, Berlin 10117, Germany
| | - Andrean Goede
- Charité Universitaetsmedizin Berlin, Institute of Physiology, Structural Bioinformatics Group, Berlin 10117, Germany
| | - Andreas Eckert
- Charité Universitaetsmedizin Berlin, Department of Information Technology, Science IT, Berlin 10117, Germany
| | - Barbara Moahamed
- Charité Universitaetsmedizin Berlin, Department of Information Technology, Science IT, Berlin 10117, Germany
| | - Robert Preissner
- Charité Universitaetsmedizin Berlin, Institute of Physiology, Structural Bioinformatics Group, Berlin 10117, Germany.,Charité Universitaetsmedizin Berlin, Department of Information Technology, Science IT, Berlin 10117, Germany
| | - Björn-Oliver Gohlke
- Charité Universitaetsmedizin Berlin, Department of Information Technology, Science IT, Berlin 10117, Germany
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4
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Held MB, Grosso MJ, Sarpong NO, Hamilton WG, Sista AK, Macaulay W. Recurrent Hemarthrosis Following Total Knee Arthroplasty. JBJS Rev 2019; 7:e2. [PMID: 31663920 DOI: 10.2106/jbjs.rvw.19.00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Recurrent hemarthrosis is a treatable complication following total knee arthroplasty that can cause debilitating symptoms that can affect outcomes following a total knee arthroplasty.» Making a diagnosis of recurrent hemarthrosis can be difficult, especially if providers are not familiar with this potential complication.» The use of lower-extremity magnetic resonance angiography has been shown to be successful in diagnosing this potential complication.» Current management strategies range from conservative therapy to targeted genicular artery embolization to arthroscopic and open synovectomy.» Prompt identification and treatment of hemarthrosis following total knee arthroplasty are critical to avoid permanent limitations of range of motion that may jeopardize the postoperative outcome.
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Affiliation(s)
- Michael B Held
- Department of Orthopaedic Surgery, New York Presbyterian Hospital and Columbia University Medical Center, New York, NY
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, New York Presbyterian Hospital and Columbia University Medical Center, New York, NY
| | - Nana O Sarpong
- Department of Orthopaedic Surgery, New York Presbyterian Hospital and Columbia University Medical Center, New York, NY
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Chundankuzhiyil Mathew A, Poothankandi A, Khader R, Chandrasekhar D. Clopidogrel-induced hemarthrosis following knee replacement. J Basic Clin Physiol Pharmacol 2019; 30:jbcpp-2019-0104. [PMID: 31469657 DOI: 10.1515/jbcpp-2019-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/30/2019] [Indexed: 06/10/2023]
Abstract
Background Clopidogrel is an adenosine diphosphate receptor antagonist used in patients with atherosclerotic vascular disease to reduce the incidence of ischemic events. Case Presentation A 62-year-old woman developed a spontaneous hemarthrosis of her left knee following clopidogrel treatment. To date, no case of spontaneous hemarthrosis following clopidogrel monotherapy was reported. Prompt aspiration after discontinuing clopidogrel by conservative management can assist early diagnosis and prevent further damage to the joint. The assessment of the causality of the event was carried out via Naranjo Causality Assessment Scale. A score of 5 was reported for this patient, indicating clopidogrel as a probable cause of this reaction. Conclusion We conclude that spontaneous hemarthrosis is a possible complication following clopidogrel therapy and it needs assessment when appropriate clinical symptoms (e.g. intra-articular effusion, pain) are present.
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Affiliation(s)
- Abel Chundankuzhiyil Mathew
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Perinthalmanna, Kerala 679322, India, Phone: +91-9645002373
| | - Athira Poothankandi
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Perinthalmanna, Kerala, India
| | - Rahana Khader
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Perinthalmanna, Kerala, India
| | - Dilip Chandrasekhar
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Perinthalmanna, Kerala, India
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6
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The Basics of Antithrombotic Medications. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Fahmy MD, Gupta A, Abdelkader A, MacKinney T, Sewall S. Clinical pathologic conference: acute onset malocclusion and facial pain. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:301-306. [DOI: 10.1016/j.oooo.2017.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/07/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
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8
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Anticoagulant-induced hemarthrosis presenting as anterior shoulder dislocation. Am J Emerg Med 2014; 32:1562.e3-4. [PMID: 25043625 DOI: 10.1016/j.ajem.2014.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022] Open
Abstract
This is a case of nontraumatic shoulder pain initially diagnosed on x-ray as an anterior dislocation. The patient was on anticoagulants and, in actuality, had severe hemarthrosis that caused the subluxation. Attempts to reduce the dislocation in this situation might have resulted in worsening of the intra-articular bleed. There has been only 1 similar reported case in the European Journal of Emergency Medicine in 2013 of a 53-year-old woman who was thought to have a nontraumatic anterior shoulder dislocation, and attempts were unsuccessful at reduction. Definitive therapy involved hemarthrosis aspiration. Others have reported spontaneous hemarthrosis due to anticoagulants; however, only 1 has reported an initial mistaken joint dislocation diagnosis. Nontraumatic hemarthrosis do occur in patients on anticoagulant therapy, and it is important to recognize that this can be misdiagnosed as a joint dislocation requiring reduction. In a patient who is on anticoagulants presenting with nontraumatic joint pain and anterior shoulder or possibly other dislocations on plain radiographs, it is pertinent to consider hemarthrosis.
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9
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Ahmed I, Gertner E. Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels. Am J Med 2012; 125:265-9. [PMID: 22340924 DOI: 10.1016/j.amjmed.2011.08.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 08/11/2011] [Accepted: 08/16/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arthrocentesis and joint injections are commonly performed for both diagnostic and therapeutic indications. Because of safety concerns, there is often reluctance to perform these procedures in patients who are receiving anticoagulation at therapeutic levels. This study was undertaken to determine the safety of arthrocentesis and joint injection performed by physicians from different disciplines in patients who are anticoagulated. METHODS We conducted a retrospective review of 640 arthrocentesis and joint injection procedures performed in 514 anticoagulated patients between 2001 and 2009. We assessed the incidence of early and late clinically significant bleeding in or around a joint, infection, and procedure-related pain. We further compared the incidence of these complications in 456 procedures performed in patients with an international normalized ratio 2.0 or greater and 184 procedures performed in patients with an international normalized ratio less than 2.0. RESULTS Only 1 procedure (0.2%) resulted in early, significant, clinical bleeding in the fully anticoagulated group. There was no statistically significant difference in early and late complications between patients who had procedures performed with an international normalized ratio 2.0 or greater and those whose anticoagulation was adjusted to an international normalized ratio less than 2.0. CONCLUSION Arthrocentesis and joint injections in patients receiving chronic warfarin therapy with therapeutic international normalized ratio are safe procedures. There does not seem to be a need for reducing the level of anticoagulation before procedures in these patients.
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Affiliation(s)
- Imdad Ahmed
- Department of Internal Medicine, Regions Hospital, St Paul, MN, USA
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10
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Ross MD, Elliott R. Acute knee haemarthrosis: a case report describing diagnosis and management for a patient on anticoagulation medication. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2010; 16:120-3. [PMID: 21043045 DOI: 10.1002/pri.491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 08/14/2010] [Accepted: 08/28/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE A 63-year-old woman was referred to physical therapy with a 3 day history of constant anterior left knee pain that was atraumatic in nature. The patient was taking anticoagulation medication for chronic atrial fibrillation. Her international normalized ratio (INR) was within normal limits when assessed 3 weeks prior to her initial physical therapy evaluation. METHOD Physical examination revealed an antalgic gait, moderate left knee effusion, limited painful knee range of motion, normal ligamentous testing and negative joint line or patellofemoral joint palpation. The patient was instructed in the use of a single-point cane, use of ice, positional comfort and relative rest from weight-bearing activities. Upon re-assessment 2 days later, the patient's knee pain and effusion had worsened despite compliance with day 1 instructions. Given that there was no clear mechanism of injury and the worsening nature of the disorder, the physical therapist discussed the case with the patient's physician, and immediate appointments for laboratory testing and potential knee aspiration were obtained. RESULTS Laboratory testing demonstrated that INR values had elevated to a supratherapeutic level of anticoagulation. Fluid from the patient's left knee was aspirated, revealing a haemarthrosis. The patient's symptoms immediately improved following aspiration. After suspending her anticoagulation medication dose for 1 day, her INR value returned to therapeutic range. She was symptom free within 3 weeks with physical therapy intervention and had remained symptom free at 1 year following the knee haemarthrosis. CONCLUSION We recommend that physical therapists screen all patients for whether or not they are taking anticoagulation medications, especially before implementation of manual therapy or therapeutic exercise interventions.
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Affiliation(s)
- Michael D Ross
- US Air Force Physical Medicine Training Programs, Fort Sam Houston, TX, USA.
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11
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Abstract
Nontraumatic haemarthrosis secondary to anticoagulant therapy is a recognized clinical problem. The involved joints are usually large weight-bearing joints, particularly the knee. We describe a case of spontaneous haemarthrosis in a 53-year-old female patient, who had been started on anticoagulant drugs after a pulmonary embolism in the past (international normalized ratio on admission: 2.4). The patient presented with acute onset of severe shoulder pain with no history of trauma. Her shoulder showed radiological signs of anterior dislocation. Attempts to relocate her shoulder under intravenous sedation with midazolam were unsuccessful. The patient subsequently underwent aspiration of the shoulder joint and made full recovery after a course of physiotherapy. The case is unusual because it occurred in a previously healthy shoulder joint and because the bleeding caused the shoulder to appear clinically and radiologically anteriorly dislocated. No history of trauma was reported before presentation; the apparent dislocation was caused solely by spontaneous haemarthrosis. This case emphasizes that it is important to consider spontaneous haemarthrosis as a possible diagnosis in patients with no history of trauma, particularly in those on anticoagulant drugs, who present with what appears to be an anterior shoulder dislocation.
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Abstract
Acute arthritis in critically ill patients may be caused by local or systemic infection, by a flare of chronic joint disease such as rheumatoid or crystal-associated arthritis, or by less common entities such as hemarthrosis. Diagnosis requires analysis of synovial fluid, and appropriate treatment is based on its findings. Prompt diagnosis and treatment are usually necessary to prevent the significant morbidity associated with these conditions.
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Affiliation(s)
- Jaya M Raj
- Mayo Graduate School of Medicine, 200 1st Street SW Siebens Building #5, Rochester, MN 55905, USA.
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13
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Dungy DS, Faulks CR. Atraumatic subacromial bursal hemorrhage in a patient on anticoagulation therapy. J Shoulder Elbow Surg 2000; 9:541-2. [PMID: 11155311 DOI: 10.1067/mse.2000.109411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- D S Dungy
- Department of Orthopaedic Surgery, George Washington University Medical Center, Washington DC, USA
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14
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Dennis VC, Thomas BK, Hanlon JE. Potentiation of oral anticoagulation and hemarthrosis associated with nabumetone. Pharmacotherapy 2000; 20:234-9. [PMID: 10678303 DOI: 10.1592/phco.20.3.234.34789] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Concomitant therapy with warfarin and nonsteroidal antiinflammatory drugs (NSAIDs) is of concern due to the potential for increased bleeding. Nonsteroidal antiinflammatory drugs may alter patient response to warfarin by pharmacodynamic or pharmacokinetic interactions. A man receiving long-term, stable warfarin therapy experienced a significant increase in international normalized ratio 1 week after nabumetone was added to his regimen. Despite prompt reduction of the warfarin dosage, he experienced hemarthrosis of his right knee. Previous reports suggested lack of interaction between nabumetone and warfarin. Caution and close monitoring are advisable when the two agents are administered concomitantly.
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Affiliation(s)
- V C Dennis
- Department of Pharmacy Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA
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Thumboo J, O'Duffy JD. A prospective study of the safety of joint and soft tissue aspirations and injections in patients taking warfarin sodium. ARTHRITIS AND RHEUMATISM 1998; 41:736-9. [PMID: 9550485 DOI: 10.1002/1529-0131(199804)41:4<736::aid-art23>3.0.co;2-p] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the safety of joint or soft tissue aspirations and injections in patients taking warfarin sodium. METHODS The outcome of 32 joint or soft tissue aspirations or injections in patients receiving stable doses of warfarin sodium was assessed through a standardized interview 4 weeks after the procedure. The primary outcome measure was significant joint or soft tissue hemorrhage, ascertained by patient-reported increases in swelling or warmth at the procedure site. RESULTS None of 32 procedures was complicated by joint or soft tissue hemorrhage reported by the patients, yielding, by the "rule of threes," a risk of significant hemorrhage of < 10% (with 95% certainty). Diagnostic information was obtained for 53% of aspirated sites (8 of 15) and therapeutic benefit was noted in 74% of corticosteroid-injected sites (17 of 23). CONCLUSION Joint or soft tissue injections and aspirations in selected patients taking warfarin sodium are associated with a low risk of hemorrhage and are often of diagnostic or therapeutic value.
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Affiliation(s)
- J Thumboo
- Mayo Clinic, Rochester, Minnesota 55905, USA
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Abstract
Thirty patients who developed recurrent hemarthrosis after total knee arthroplasty were followed for an average of 27.9 months. The average interval between implantation of the prosthesis and the first bleed was 24.2 months. Nine knees responded to conservative care alone. The remaining 21 knees continued to have recurrent bleeds requiring surgical intervention. Open synovectomy was performed in 15 knees and seemed to be curative in 14 (93%). Forty-three percent of the surgically treated knees were noted to have entrapment of proliferative synovial tissue or the fat pad between prosthetic components as the cause of the recurrent bleeds. Consistent histologic findings included focal synovial hyperplasia and significant hemosiderin deposition. Although similar, these changes should not be confused with those of pigmented villonodular synovitis.
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Affiliation(s)
- K Kindsfater
- Brigham & Women's Hospital and New England Baptist Hospital, Boston, Massachusetts, USA
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Ballard WT, Clark CR, Callaghan JJ. Recurrent spontaneous hemarthrosis nine years after a total knee arthroplasty. A presentation with pigmented villonodular synovitis. J Bone Joint Surg Am 1993; 75:764-7. [PMID: 8501094 DOI: 10.2106/00004623-199305000-00018] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- W T Ballard
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242
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Espinoza LR, Vasey FB, Espinoza CG, Bocanegra TS, Germain BF. Vascular changes in psoriatic synovium. A light and electron microscopic study. ARTHRITIS AND RHEUMATISM 1982; 25:677-84. [PMID: 7092966 DOI: 10.1002/art.1780250611] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Light and electron microscopic studies were performed on the synovial membranes from the large joints of 12 patients with psoriatic arthritis. The most significant histopathologic findings were vascular changes that were characterized by endothelial cell swelling accompanied by inflammatory cell infiltration and marked thickening of the vessel wall. Fibrosis of the subsynoviocyte tissue was also prominent, especially in patients with chronic disease. Villi were not prominent, and the lining layer was not thickened. Both type A and B cells were seen; none had significant abnormalities. No electrondense deposits were observed. These findings lend further support to the theory that microvascular changes play a significant role in the pathogenesis of psoriasis and its related arthritis.
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Klofkorn RW, Lightsey AL. Hemarthrosis associated with Glanzmann's thrombasthenia. ARTHRITIS AND RHEUMATISM 1979; 22:1390-3. [PMID: 518722 DOI: 10.1002/art.1780221212] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Mintz G, Robles-Saavedra EJ, Enríquez RD, Jiménez FJ, Juán ML. Hemarthrosis as the presenting manifestation of true myeloma joint disease. ARTHRITIS AND RHEUMATISM 1978; 21:148-51. [PMID: 623685 DOI: 10.1002/art.1780210124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This is the first reported of a patient with hemarthrosis due to invasion of the synovial membrane by myeloma cells. With angiographic studies of the affected joint it was apparent that the tumor tissue extended from the destructive bone lesion of the femoral condyle into the synovial membrane. Intraarticular spontaneous bleeding was the first manifestation of a monoclonal IgG multiple myeloma; the hemarthrosis recurred after drainage but was controlled with local roentgen therapy.
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Espinoza LR, Lauter S, Vasey F, Osterland CK. Hemarthrosis in psoriatic arthritis. ARTHRITIS AND RHEUMATISM 1977; 20:1034-5. [PMID: 861064 DOI: 10.1002/art.1780200427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Good AE, Pozderac RB. Ecchymosis of the lower leg. A sign of hemarthrosis with synovial rupture. ARTHRITIS AND RHEUMATISM 1977; 20:1009-13. [PMID: 861062 DOI: 10.1002/art.1780200415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Four patients with hemarthrosis of the knee, synovial rupture, and ecchymoses are reported. The patients presented with calf pain and swelling and large ecchymoses, which eventually extended to the ankle as a crescent about one or both malleoli. Appreciation of this physical sign, which appears to be characteristic for the hemorrhagic subset of synovial rupture, should alert the physician to the correct diagnosis and steer him away from contraindicated anticoagulant therapy.
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