Is Joint Aspiration or Injection Safe in Patients Taking Direct-Acting Oral Anticoagulants?

Some practitioners are reluctant to perform joint aspiration or injection procedures in anticoagulated patients because of heightened risk for bleeding. Studies have shown that this risk is low (≤0.2%) in patients with international normalized ratios (INRs) between 2.0 and 3.0 who take warfarin, but risk for bleeding in patients who take direct-acting oral anticoagulants (DOACs) has not been reported. In this retrospective review of medical records, Mayo Clinic researchers assessed bleeding complications in 483 patients who took DOACs (i.e., rivaroxaban [Xarelto], apixaban [Eliquis], and dabigatran [Pradaxa]) and who underwent a total of 1050 arthrocentesis procedures or joint or bursa injections during a 6-year period.

In 22% of procedures,…