Maintaining anticoagulant treatment in hand surgery – a review of 63 procedures

Interruption and resumption of anticoagulant is at risk of high morbidity (thrombosis, hematoma) during or after hand surgery. Local anesthesia including epinephrin enables good hemostasis during and after surgery. Authors argue anticoagulant may be taken as usual, without interruption, if the surgery is performed using a local anesthesia with epinephrin. Authors described their experience of hand procedures without interruption of anticoagulant or strong antiaggregant treatment (clopidogrel) in a continuous series of 63 procedures. Over a period of 2.5 years, 63 continuous procedures (43 patients) were included. All procedures were operated on with a chronic treatment of anticoagulant (41), a strong antiaggregant treatment clopidogrel (19) or both (3). Concerning procedures under anticoagulant, 8 procedures were performed with a strong anticoagulant treatment (INR 3–4.5). Among 63 procedures, there were 28 carpal tunnel, 18 trigger fingers, 12 Dupuytrenu0027s contracture, 1 de Quervain tendinitis, 3 digital tumors. Fasting was forbidden. The surgery was performed under local anesthesia using epinephrine 1%, following the WALANT procedure. Mean duration between anesthesia and surgery was 17 minutes (12–40). All procedures were performed with percutaneous ultrasound guidance, excepted for digital tumors. We evaluated 2 criteria-excessive bleeding during the surgery and postoperative hematoma. The 3 cases of open surgeries (digital tumors) necessitated basic gestures of haemostasis. All ultrasound-assisted surgeries were performed without hemostasis gestures. None hematoma was observed or reported after surgery. This is a short series but we did not report specific bleeding or hematoma during or after surgery, either for anticoagulant or strong antiaggregant treated patients Local anesthesia with epinephrin is a relevant way to avoid interruption of anticoagulant treatment and preventing bleeding complications.