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.

中文翻译：

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口服抗凝剂患者关节出血的处理

目标

我们的目的是调查因急性关节积血入院并同时服用口服抗凝剂的患者的管理，并强调不同管理策略的结果。

方法

对伦敦地区总医院骨科在 42 个月（2015 年 1 月至 2018 年 7 月）期间所有骨科入院进行了回顾性审查。确定了所有因自发性关节积血而入院并同时使用口服抗凝剂的患者。匿名数据被放置在一个安全的信任数据库中。

发现

共纳入 31 名患者。22 名患者（71%）在入院期间暂时停用了抗凝剂。9 名患者 (32%) 用 10 毫克维生素 K 逆转了抗凝作用。5 名患者在入院时或住院期间吸入了关节积血。关节积血患者的总体平均住院时间为 7.0 天。接受抗凝治疗的患者平均住院时间为 8.6 天。相比之下，继续服用抗凝剂的患者平均住院时间为 2.3 天。在出院后的 60 天内，没有患者发生血栓事件。联合抽吸后没有记录到不良事件。

结论

目前对于口服抗凝剂患者的关节积血的管理尚无共识。继续使用抗凝剂并没有增加住院时间。进一步的研究可能侧重于评估管理辅助对患者结果的影响及其成本效益，以帮助制定地方和/或国家指南。