Michael Mcculloch1, Arian Nachat2, Jonathan Schwartz3, Vicki Casella-Gordon4, Joseph Cook5. 1. Research Lead for Integrative Medicine at the Walnut Creek Hospital in CA and a Research Chief at the Pine Street Foundation in San Anselmo, CA. michael.f.mcculloch@kp.org. 2. Director of Integrative Medicine at the Walnut Creek Hospital in CA. arian.nachat@kp.org. 3. Research Intern in Integrative Medicine at the Walnut Creek Hospital in CA. jjschwar@princeton.edu. 4. Clinical Nurse Specialist in Integrative Medicine at the Walnut Creek Hospital in CA. vicki.gordon@kp.org. 5. Research Intern in Integrative Medicine at the Walnut Creek Hospital in CA. cookjos1@yahoo.com.
Abstract
INTRODUCTION: Theoretically, acupuncture in anticoagulated patients could increase bleeding risk. However, precise estimates of bleeding complication rates from acupuncture in anticoagulated patients have not been systematically examined. OBJECTIVE: To critically evaluate evidence for safety of acupuncture in anticoagulated patients. METHODS: We searched PubMed, EMBASE, the Physiotherapy Evidence Database, and Google Scholar. RESULTS: Of 39 potentially relevant citations, 11 met inclusion criteria: 2 randomized trials, 4 case series, and 5 case reports. Seven provided reporting quality sufficient to assess acupuncture safety in 384 anticoagulated patients (3974 treatments). Minor-moderate bleeding related to acupuncture in an anticoagulated patient occurred in one case: a large hip hematoma, managed with vitamin K reversal and warfarin discontinuation following reevaluation of its medical justification. Blood-spot bleeding, typical for any needling/injection and controlled with pressure/cotton, occurred in 51 (14.6%) of 350 treatments among a case series of 229 patients. Bleeding deemed unrelated to acupuncture during anticoagulation, and more likely resulting from inappropriately deep needling damaging tissue or from complex anticoagulation regimens, occurred in 5 patients. No bleeding was reported in 2 studies (74 anticoagulated patients): 1 case report and 1 randomized trial prospectively monitoring acupuncture-associated bleeding as an explicit end point. Altogether, 1 moderate bleeding event occurred in 3974 treatments (0.003%). CONCLUSION: Acupuncture appears to be safe in anticoagulated patients, assuming appropriate needling location and depth. The observed 0.003% complication rate is lower than the previously reported 12.3% following hip/knee replacement in a randomized trial of 27,360 anticoagulated patients, and 6% following acupuncture in a prospective study of 229,230 all-type patients. Prospective trials would help confirm our findings.
INTRODUCTION: Theoretically, acupuncture in anticoagulated patients could increase bleeding risk. However, precise estimates of bleeding complication rates from acupuncture in anticoagulated patients have not been systematically examined. OBJECTIVE: To critically evaluate evidence for safety of acupuncture in anticoagulated patients. METHODS: We searched PubMed, EMBASE, the Physiotherapy Evidence Database, and Google Scholar. RESULTS: Of 39 potentially relevant citations, 11 met inclusion criteria: 2 randomized trials, 4 case series, and 5 case reports. Seven provided reporting quality sufficient to assess acupuncture safety in 384 anticoagulated patients (3974 treatments). Minor-moderate bleeding related to acupuncture in an anticoagulated patient occurred in one case: a large hip hematoma, managed with vitamin K reversal and warfarin discontinuation following reevaluation of its medical justification. Blood-spot bleeding, typical for any needling/injection and controlled with pressure/cotton, occurred in 51 (14.6%) of 350 treatments among a case series of 229 patients. Bleeding deemed unrelated to acupuncture during anticoagulation, and more likely resulting from inappropriately deep needling damaging tissue or from complex anticoagulation regimens, occurred in 5 patients. No bleeding was reported in 2 studies (74 anticoagulated patients): 1 case report and 1 randomized trial prospectively monitoring acupuncture-associated bleeding as an explicit end point. Altogether, 1 moderate bleeding event occurred in 3974 treatments (0.003%). CONCLUSION: Acupuncture appears to be safe in anticoagulated patients, assuming appropriate needling location and depth. The observed 0.003% complication rate is lower than the previously reported 12.3% following hip/knee replacement in a randomized trial of 27,360 anticoagulated patients, and 6% following acupuncture in a prospective study of 229,230 all-type patients. Prospective trials would help confirm our findings.
Authors: M Kay Garcia; Jennifer McQuade; Robin Haddad; Sonya Patel; Richard Lee; Peiying Yang; J Lynn Palmer; Lorenzo Cohen Journal: J Clin Oncol Date: 2013-01-22 Impact factor: 44.544
Authors: D Farge; P Debourdeau; M Beckers; C Baglin; R M Bauersachs; B Brenner; D Brilhante; A Falanga; G T Gerotzafias; N Haim; A K Kakkar; A A Khorana; R Lecumberri; M Mandala; M Marty; M Monreal; S A Mousa; S Noble; I Pabinger; P Prandoni; M H Prins; M H Qari; M B Streiff; K Syrigos; H Bounameaux; H R Büller Journal: J Thromb Haemost Date: 2013-01 Impact factor: 5.824