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

Sardenberg, Trajano; Deienno, Francisco Simões; Miranda, Raffaello de Freitas; Varanda, Denis; Cortopassi, Andréa Christina; Silvares, Paulo Roberto de Almeida

doi:10.1016/j.rboe.2017.07.001

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REVIEW ARTICLE • Rev. bras. ortop. 52 (04) • Jul-Aug 2017 • https://doi.org/10.1016/j.rboe.2017.07.001 copy

Hand and wrist surgery without suspending warfarin or oral antiplatelet - systematic review^☆ ☆ Study conducted at Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
Hand/surgery; Anticoagulants; Warfarin

Authors	Type of study	Tourniquet use	AT	Number of surgeries		Mild complications		Severe complications		Total complications
				With AT	Without AT	With AT	Without AT	With AT	Without AT
Smit and Hooper⁹ (2004)	Cohort study (retrospective)	Yes	Warfarin (INR ≤ 3) and clopidogrel	23 (22 with warfarin and 1 with clopidogrel)	1.370	1 (Bleeding/clopidogrel)	Zero	Zero	Zero	1 (4.3%) (With AT)
Wallace et al.¹⁰ (2004)	Non-controlled clinical series (retrospective)	Yes	Warfarin (INR 1.3–2.9)	55	Does not refer	2 (hematoma)	Does not refer	Zero	Zero	2 (3.6%) (With AT)
Jivan et al.¹¹ (2008)	Case-control studies (retrospective)	Yes	ASA	48	48	Zero	Zero	Zero	Zero	Zero (with and without AT)
Edmunds and Avakian¹² (2010)	Non-controlled clinical series (prospective)	Yes	Warfarin (INR 1.4–3.2) clopidogrel and ASA + clopidogrel	121 (57 warfarin, 40 with clopidogrel, and 24 with clopidogrel + ASA)	Does not refer	6 (bleeding; 5 clopidogrel and 1 with ASA + clopidogrel)	Does not refer	1 (hematoma/clopidogrel)	Zero	7 (5.8%) (With AT)
Boogaarts et al.¹³ (2010)	Cohort study (retrospective)	No (local anesthesia with epinephrine)	ASA	6	448	Zero	Zero	Zero	Zero	Zero (with and without AT)
Bogunovic et al.⁵ (2013)	Cohort study (prospective)	Yes	clopidogrel, ASA, and ASA + clopidogrel	107	107	15 (hematoma)	13 (hematoma)	1 (bleeding/high dose of ASA)	Zero	16 (15%) with AT 13 (12.1%) without AT
Bogunovic et al.⁶ (2015)	Cohort study (prospective)	Yes	Warfarin (mean INR 2.3); 18 warfarin + ASA	50 (32 warfarin and 18 with warfarin + ASA)	50	14 (hematoma)	5 (hematoma)	1 (hematoma + median nerve compression)	Zero	15 (30%) with AT 5 (10%) without AT
Total				410	2023	38 (9.2%)	18 (0.8%)	3 (0.7%)	Zero	41 (10%) with AT 18 (0.8%) without AT

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: tsarden@fmb.unesp.br (T. Sardenberg).

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Hand and wrist surgery without suspending warfarin or oral antiplatelet - systematic review☆ ☆ Study conducted at Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil.

ABSTRACT

Hand and wrist surgery without suspending warfarin or oral antiplatelet - systematic review^☆ ☆ Study conducted at Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil.