A Delphi-Based Consensus Statement on the Management of Anticoagulated Patients With Botulinum Toxin for Limb Spasticity.
Arch Phys Med Rehabil
; 99(11): 2183-2189, 2018 11.
Article
en En
| MEDLINE
| ID: mdl-29803825
ABSTRACT
OBJECTIVE:
To create a consensus statement on the considerations for treatment of anticoagulated patients with botulinum toxin A (BoNTA) intramuscular injections for limb spasticity.DESIGN:
We used the Delphi method.SETTING:
A multiquestion electronic survey.PARTICIPANTS:
Canadian physicians (N=39) who use BoNTA injections for spasticity management in their practice.INTERVENTIONS:
After the survey was sent, there were e-mail discussions to facilitate an understanding of the issues underlying the responses. Consensus for each question was reached when agreement level was ≥75%. MAIN OUTCOMEMEASURES:
Not applicable.RESULTS:
When injecting BoNTA in anticoagulated patients (1) BoNTA injections should not be withheld regardless of muscles injected; (2) a 25G or smaller size needle should be used when injecting into the deep leg compartment muscles; (3) international normalized ratio (INR) level should be ≤3.5 when injecting the deep leg compartment muscles; (4) if there are clinical concerns such as history of a fluctuating INR, recent bleeding, excessive or new bruising, then an INR value on the day of injection with point-of-care testing or within the preceding 2-3 days should be taken into consideration when injecting deep compartment muscles; (5) the concern regarding bleeding when using direct oral anticoagulants (DOACs) should be the same as with warfarin (when INR is in the therapeutic range); (6) the dose and scheduling of DOACs should not be altered for the purpose of minimizing the risk of bleeding prior to BoNTA injections.CONCLUSIONS:
These consensus statements provide a framework for physicians to consider when injecting BoNTA for spasticity in anticoagulated patients. These consensus statements are not strict guidelines or decision-making steps, but rather an effort to generate common understanding in the absence of evidence in the literature.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Toxinas Botulínicas Tipo A
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Anticoagulantes
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Espasticidad Muscular
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Fármacos Neuromusculares
Tipo de estudio:
Etiology_studies
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Guideline
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Prognostic_studies
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Qualitative_research
/
Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
País como asunto:
America do norte
Idioma:
En
Año:
2018
Tipo del documento:
Article