Joint Injections while on Warfarin

[BionicBuddy]

Hi again. You have all been so helpfully informative.

For those on Warfarin, what do you do about injections right into the joint for sports injuries/ osteoarthritis/ etc.?

Injections like cortisone, Synovisc, prolotherapy, etc.?

What about a less invasive Rx like acupuncture?

Do you not do it because of potential bleeding into the joint? Do you "bridge"? Or do you not worry about it and go ahead and do it because it's not a big deal?

Thanks in advance!

 

[pellicle]

I've had accupuncture ... no problems.

There is no blood in your joints.

 

[BionicBuddy]

I've had accupuncture ... no problems.

There is no blood in your joints.

Great. I figured that was the case. Thanks for confirming Pellicle!

What about deep injections right into the joint (like cortisone, Synovisc, prolotherapy)?

True, joints (synovial capsule, cartilage, etc.) are primarily avascular, however, there is the periarticular vascular plexus that surrounds the joint, and when you pierce the skin with a needle and go right into the joint itself, you will go through a vascular plexus that feeds the joint capsule, etc. I was wondering if this would be problematic for people on Warfarin?

Is there any athlete on this forum who gets prolo? Or any older folks who get cortisone shots for OA?

Thanks again in advance!

 

[pellicle]

Hi

I guess that its good to hold a model of what is happening in your mind while doing thinking about it. So lets use this one:

there is no blood in the capsule as you mention

Great. I figured that was the case. Thanks for confirming

so

What about deep injections right into the joint (like cortisone, Synovisc, prolotherapy)?

the same really ...

True, joints (synovial capsule, cartilage, etc.) are primarily avascular, however, there is the periarticular vascular plexus that surrounds the joint, and when you pierce the skin with a needle and go right into the joint itself, you will go through a vascular plexus that feeds the joint capsule, etc.

yes, but now apply the thinking to how the injection gets there, via the insertion of a needle which being sharp and metal pierces all the way though to the membrane and beyond into the interior. While it is present it is blocking everything along the shaft and the liquid (drug and solvent {probably saline}) is injected via the tip. This increases pressure inside the capsule (because it inflated it slightly) and creates a puncture.

Upon removal some of the capsule contents will leave via that puncture and some blood may get in there. I don't know what mechanism the capsule has for healing, but I know that joint capsules do heal.

With every procedure there is risk. I don't know the mechanism the body has for clearing any blood from this area or in detail what harm comes to the body as a result. I can say I've had a torn meniscus in my knee while I was on warfarin and 5 years later its "mostly good" ... I'd imagine that was FAR more trauma than a needle.

Hopefully someone else can answer your question from the athletic perspective.

Now, if I may ask you: what is the reason you're asking all these questions? Are you using this to make a decision of pro and con of a mechanical valve? If so let me say this: life has a habit of making what we think are bigger issues into insignificant ones, what we think at some point to be really important turns out to be the least of our worries.

Best Wishes

 

[QuincyRunner]

I have had cortisone shots without any problem and just last year I had a couple of PRP (Platelet Rich Plasma) injections into a torn meniscus (knee) without any concerns or bleeding as a result of Warfarin. It was never suggested that I bridge and I didn't even lower my INR beforehand. By the way, I was scheduled for surgery to repair the meniscus but pushed for this less invasive technique and boy am I glad I did because in about three months it was healed and I was back to running. The orthopedic surgeon was skeptical that the PRP injection would work on me given my "advanced age" of 64!

 

[BionicBuddy]

I can say I've had a torn meniscus in my knee while I was on warfarin and 5 years later its "mostly good" ... I'd imagine that was FAR more trauma than a needle.

Possibly, depending on the trauma sustained (affecting other supporting tissues other than just the meniscus which is avascular), and depending on what type of injection is done, and etc.

Now, if I may ask you: what is the reason you're asking all these questions? Are you using this to make a decision of pro and con of a mechanical valve? If so let me say this: life has a habit of making what we think are bigger issues into insignificant ones, what we think at some point to be really important turns out to be the least of our worries.

My husband would not have been able to play full-out basketball until age of 59 without having had prolotherapy for his knees. He wouldn't have been able to recently and intensely hike up the mountains he did without having had prolotherapy for his ankle. I imagine in the future he may need some more prolo due to aging/old injuries. If he went with the mechanical valve, it is likely he would decline prolotherapy if Warfarin was more than a relative contraindication, which would be a drag for him.

So no, this topic doesn't even make our top 10 list of pros/cons. I was just wondering in case he chooses the mechanical.

Best Wishes

Thanks!

 

[BionicBuddy]

I have had cortisone shots without any problem and just last year I had a couple of PRP (Platelet Rich Plasma) injections into a torn meniscus (knee) without any concerns or bleeding as a result of Warfarin. It was never suggested that I bridge and I didn't even lower my INR beforehand. By the way, I was scheduled for surgery to repair the meniscus but pushed for this less invasive technique and boy am I glad I did because in about three months it was healed and I was back to running. The orthopedic surgeon was skeptical that the PRP injection would work on me given my "advanced age" of 64!

Exactly what I hoped to hear!!! Fantastic!!!! Yes, PRP and prolo are amazing when well-indicated.

 

[pellicle]

Hi

If he went with the mechanical valve, it is likely he would decline prolotherapy if Warfarin was more than a relative contraindication, which would be a drag for him.

I've never heard of it being a contraindication ... further I've never heard of it causing bleeding complications. However I see at least Qunicy has given you some (one) aspect.

So no, this topic doesn't even make our top 10 list of pros/cons. I was just wondering in case he chooses the mechanical.

understood.

I've noticed that (psychology hat on) most people believe the first opinion they get which "supports their view"; be that negative of positive as a view. But I noticed also that if one person reports bad it needs like 9 (or 9,999 as it were) good reports and still the one bad report will be what sticks in their mind.



It is however wise and prudent to get opinions.

Good luck with surgery and I hope that you have a straightforward surgery and an event free recovery.

 

[BionicBuddy]

But I noticed also that if one person reports bad it needs like 9 (or 9,999 as it were) good reports and still the one bad report will be what sticks in their mind.

Yes, we human creatures are interesting species.

Good luck with surgery and I hope that you have a straightforward surgery and an event free recovery.

Well, we haven't even had a CTA yet, nor a repeat echo to confirm the abysmal readings we got in November. We see the cardio next month. But yes, thanks. Once we get a referral to the surgeon, I'll be scouring this site for pre and post op tips and recommendations so we can have an event free recovery as much as possible.

 

[pellicle]

I'll be scouring this site for pre and post op tips and recommendations so we can have an event free recovery as much as possible.

I know at least one person will be facepalming when I say this, but Kimchi on your first few meals when back on the ward. Helps loosen up what the opiates solidify.
https://www.valvereplacement.org/th...rmally-given-after-surgery.42700/#post-777281

 

[tom in MO]

My experience is cortisone in the knee is not affected by warfarin. You can get those as if you were not on warfarin. Steroid shots in the spine at the neck, with a needle guided by imagining for a pinched nerve, I had to go off warfarin and drop my INR, restarted the day after injection. There is a small possibility of bleeding in that procedure which they want to minimize since it is not good for the spine. Not having to bridge is valve dependent though, mine being a mechanical St. Jude in the aortic position.

In my view, the worst thing about warfarin therapy is you cannot take NSAIDs for arthritis. At best, OTC doses of ibuprofen for not more than 2 months.

 

[BionicBuddy]

Not having to bridge is valve dependent though, mine being a mechanical St. Jude in the aortic position.

It appears (if hubby chooses mechanical), we will need to educate ourselves on 'bridging' as well as mechanical valve choices (if we even get a choice, which I doubt we will).

Thanks!

 

[dwhist]

Great. I figured that was the case. Thanks for confirming Pellicle!

What about deep injections right into the joint (like cortisone, Synovisc, prolotherapy)?

True, joints (synovial capsule, cartilage, etc.) are primarily avascular, however, there is the periarticular vascular plexus that surrounds the joint, and when you pierce the skin with a needle and go right into the joint itself, you will go through a vascular plexus that feeds the joint capsule, etc. I was wondering if this would be problematic for people on Warfarin?

Is there any athlete on this forum who gets prolo? Or any older folks who get cortisone shots for OA?

Thanks again in advance!

I have had numerous cortisone shots in both knees and right shoulder with no issues while on Warfarin.

 

[mlewis30]

My knee was drained yesterday, followed by a steroid injection. Of course, my orthopedist knows about my double mechanical valves and daily warfarin regiment. The fluid removed from the knee had some blood, but but primarily synovial fluid - all within normal limits. My INR checked out fine today.

 

[pellicle]

On this point

mechanical valve choices

St Jude , ask @nobog about models (for reference I have an ATS , so no #metoo bias)

 

[carolinemc]

It appears (if hubby chooses mechanical), we will need to educate ourselves on 'bridging' as well as mechanical valve choices (if we even get a choice, which I doubt we will).

Thanks!

Bridging is used for certain procedures, dental and other things. If you do not have too much going on, bridging is easy and they monitor you on it. If he goes with mechanical. And I have been mechanical St. Jude's leaflet valve since 2001.

 

[Nick Drew]

I have 3 Ostenil injections in my knee over 3 weeks every six months with no problems at all

 

[pellicle]

I have 3 Ostenil injections in my knee over 3 weeks every six month

ouch ... can I ask,

• is it working well,
• after administration how long does it help for
• does its efficacy diminish in duration over time
• is the end game a knee replacement (or is this likely to keep working

pardon me, but I've got a Dicky Nee too

 

[Nick Drew]

for me i have been on them for about 4 years and aligned to walking and exercising it works well. You can get 4 good months from it and then its starts up again so yes over that period it does diminish somewhat but my knee is no worse than it was when i started and if anything it allows me to continue being active even doing some walking football(soccer) which is a thing in the UK. End game could be a new knee but i am going to work as hard as i can to avoid one and the doctor who gives me the *** is very hopeful we will avoid that. After seeing some of the new knee disasters of some of my friends i really hope i can .For context i was an active soccer player from age 11 to 42 and even then kept doing five a side games etc but was a goal keeper which relied on a lot of long power kicking during games.

 

[Protimenow]

I've had cortisone injections and a few times when I had synovial cysts (Baker's cysts), I've had LARGE amounts of fluids removed from my knees. The orthopedist or rheumatologist used ultrasound to place the needle where it wouldn't damage nerves or tendons. I didn't have to do anything about my INR before any of these procedures.

As far as bridging goes, I haven't encountered any situations where I thought it was necessary - although reducing the INR before some procedures may be necessary, I start warfarin after the procedure and within about 3 days my INR is back where I want it. It takes more than 3 days for a clot to form.

Maybe if I was having something more major - it would probably be in a hospital or as an outpatient procedure - they may give me heparin, making 'bridging' unnecessary.

I had a pacemaker 'installed' when I was fully anticoagulated, and there were no issues.

The only time that bridging might be appropriate (in my mind, at least) is if a procedure is done that presents a significant risk of clotting post-op. (Clotting between the time of the procedure and the time that my INR is back where I want it).