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Risk of bleeding associated with interventional musculoskeletal radiology procedures. A comprehensive review of the literature

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Abstract

This review compiles the current literature on the bleeding risks in common musculoskeletal interventional procedures and attempts to provide guidance for practicing radiologists in making decisions regarding the periprocedural management of patients on antithrombotic therapy. The practitioner must weigh the risk of bleeding if therapy is continued against the possibility a thromboembolic occurring if anticoagulation therapy is withheld or reversed. Unfortunately, there is little empirical data to guide evidence-based decisions for many musculoskeletal interventions. However, a review of the literature shows that for low-risk procedures, such as arthrograms/arthrocenteses or muscle/tendon sheath injections, bleeding risks are sufficiently small that anticoagulants and antiplatelet therapies need not be withheld. Additionally, relatively higher-risk procedures, such as needle biopsies of bone and soft tissue, may be safely performed without holding antithrombotic therapy, provided pre-procedural INR is within therapeutic range. Thus, while a patient’s particular clinical circumstances should dictate optimal individualized management, anticoagulation alone is not a general contraindication to most interventional musculoskeletal radiology procedures.

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The authors declare that they have no conflicts of interest. No human or animal studies were involved in this manuscript.

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Authors and Affiliations

  1. Department of Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 NW 12th Ave., JMH WW 279, Miami, FL, 33136, USA

    Gregory B. Foremny, Jean Jose & Ty K. Subhawong

  2. Department of Orthopaedic Surgery-Division of Musculoskeletal Oncology, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL, 33136, USA

    Juan Pretell-Mazzini

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  1. Gregory B. Foremny
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Correspondence to Ty K. Subhawong.

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Foremny, G.B., Pretell-Mazzini, J., Jose, J. et al. Risk of bleeding associated with interventional musculoskeletal radiology procedures. A comprehensive review of the literature. Skeletal Radiol 44, 619–627 (2015). https://doi.org/10.1007/s00256-014-2065-5

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