1
|
Rajendran V. Practice recommendations for physiotherapists in Canada managing adverse events associated with acupuncture. Acupunct Med 2024; 42:155-165. [PMID: 38706181 DOI: 10.1177/09645284241248468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
In Canada, acupuncture is a regulated medical practice that involves inserting thin needles at specific points on the body to alleviate pain and other health conditions. Acupuncture is a controlled act in physiotherapy practice. Therefore, physiotherapists who incorporate acupuncture into their practice should have the necessary education and roster this controlled act with the regulatory college in their province. Although acupuncture can be helpful, potential complications can arise, ranging from minor bruising to life-threatening conditions such as pneumothorax and cardiac tamponade. This article provides information on the potential adverse effects of acupuncture and provides recommendations for physiotherapists regarding prevention and management of any incidents that may arise during treatment.
Collapse
Affiliation(s)
- Venkadesan Rajendran
- Acute Stroke and Internal Medicine Unit, Health Sciences North, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| |
Collapse
|
2
|
Caldeira D, Rodrigues BS, Alves M, Pinto FJ, Ferreira JJ. Low risk of haematomas with intramuscular vaccines in anticoagulated patients: a systematic review with meta-analysis. Thromb J 2022; 20:9. [PMID: 35172841 PMCID: PMC8848629 DOI: 10.1186/s12959-022-00367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction The summary of product characteristics of vaccines administered intramuscularly, including the vaccine for coronavirus SARS-CoV-2 (COVID-19) and Influenza, warned for risks of bleeding in patients treated with oral anticoagulants. We aimed to estimate the incidence of major bleeding events in this setting and to compare these risks against other vaccination routes. Methods This systematic review included all prospective and retrospective studies enrolling anticoagulated patients that received intramuscular vaccination, published until December 2020 in CENTRAL, MEDLINE and EMBASE. The outcomes of interest were major bleeding and haematoma related with vaccination. The incidence of the outcomes was estimated through a random-effects meta-analysis using the Freeman-Turkey transformation. The results are expressed in percentages, with 95%-confidence intervals (95%CI), limited between 0 and 100%. When studies compared intramuscular vaccination vs. other route, the data were compared and pooled using random-effects meta-analysis. Risk ratios (RR) with 95%CI were reported. Results Overall 16 studies with 642 patients were included. No major bleeding event was reported. The pooled incidence of haematomas following vaccination (mostly against Influenza) in patients treated with oral anticoagulants (mostly warfarin; no data with DOACs / NOACs) was 0.46% (95%CI 0-1.53%). Three studies evaluated the intramuscular vs. subcutaneous route of vaccination. Intramuscular vaccines did not increase the risk of haematoma (RR 0.53, 95%CI 0.10-2.82) compared with subcutaneous route. Conclusions Intramuscular vaccination in anticoagulated patients is safe with very low incidence of haematomas and the best available evidence suggests that using the intramuscular route does not increase the risk of haematomas compared with the subcutaneous route. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-022-00367-1.
Collapse
Affiliation(s)
- Daniel Caldeira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal. .,Centro Cardiovascular da Universidade de Lisboa - CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal. .,Cardiology Department, Hospital Universitário de Santa Maria - CHULN, Santa Maria, Portugal. .,Laboratório de Farmacologia Clínica e Terapêutica - CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisboa, Portugal.
| | | | - Mariana Alves
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Medicina III, Hospital Pulido Valente, CHLN, Lisboa, Portugal
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa - CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Cardiology Department, Hospital Universitário de Santa Maria - CHULN, Santa Maria, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| |
Collapse
|
3
|
Perrin G, Beller CL, Darnige L, Khider L, Smadja DM, Lillo-Le Louet A, Planquette B, Lebeaux D, Sanchez O, Sabatier B, Mirault T, Gendron N. Intramuscular Vaccination in Adults with Therapeutic Anticoagulation in the Era of COVID-19 Vaccines Outbreak: A Practical Review. TH OPEN 2021; 5:e166-e170. [PMID: 34056523 PMCID: PMC8149207 DOI: 10.1055/s-0041-1729627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Germain Perrin
- Département de Pharmacie, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Information Sciences to support Personalized Medicine, Université de Paris, INSERM, Paris, France
| | - Christine Le Beller
- Département de Pharmacovigilance, Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
| | - Luc Darnige
- Hematology department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
| | - Lina Khider
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, PARCC U970 INSERM Paris, France
| | - David M Smadja
- Hematology department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France.,F-CRIN INNOVTE, Saint-Étienne, France
| | - Agnès Lillo-Le Louet
- Département de Pharmacovigilance, Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
| | - Benjamin Planquette
- F-CRIN INNOVTE, Saint-Étienne, France.,Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique - Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
| | - David Lebeaux
- Infectious Disease Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, Paris, France
| | - Olivier Sanchez
- F-CRIN INNOVTE, Saint-Étienne, France.,Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique - Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
| | - Brigitte Sabatier
- Département de Pharmacie, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Information Sciences to support Personalized Medicine, Université de Paris, INSERM, Paris, France
| | - Tristan Mirault
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, PARCC U970 INSERM Paris, France
| | - Nicolas Gendron
- Hematology department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
| |
Collapse
|
4
|
The risk of intramuscular haematoma is low following injection of benzathine penicillin G in patients receiving concomitant anticoagulant therapy. J Thromb Thrombolysis 2021; 50:237-238. [PMID: 31820262 DOI: 10.1007/s11239-019-02013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The use of intramuscular injections is widely recommended to be avoided in patients who are prescribed anticoagulant agents, both oral and parenteral due to concerns of haematoma. Benzathine penicillin G (BPG), administered via intramuscular injection, is a vital treatment component for patients with rheumatic heart disease. BPG must be administered long term (for at least a decade) as part of treatment and alternative options to intramuscular injection are currently limited. Many of these patients with rheumatic heart disease will also require long term or lifelong anticoagulation. Our retrospective, single centre study of 48 adult and paediatric hospitalised patients, 29 of which were receiving concomitant anticoagulants, demonstrates no significant bleeding complications from intramuscular administration of BPG on the day of intramuscular injection and for 7 days post injection or until hospital discharge. In the absence of practical alternatives for patients with rheumatic heart disease, our local data supports continuing intramuscular injection of BPG in patients with rheumatic heart disease receiving anticoagulant medication.Letter to the editor.
Collapse
|