From the Guidelines
For shoulder aspiration, ASA 81 mg (low-dose aspirin) typically does not need to be held, but tinzaparin 4500 units should be held for at least 12 hours before the procedure. This recommendation is based on the fact that low-dose aspirin poses minimal bleeding risk during joint aspirations, and the cardiovascular risk of stopping it often outweighs the small bleeding risk, as suggested by the ACC/AHA 2007 guidelines 1. On the other hand, tinzaparin, a low molecular weight heparin anticoagulant, carries a higher bleeding risk and should be temporarily discontinued, as indicated by the prescribing information for Innohep (tinzaparin sodium injection) 1.
Some key points to consider when making this decision include:
- The patient's individual risk factors for bleeding and cardiovascular events
- The specific procedure being performed and its associated bleeding risks
- The patient's renal function and other factors that may affect the metabolism and clearance of tinzaparin
- The need for close monitoring and follow-up after the procedure to minimize the risk of bleeding complications
After the procedure, tinzaparin can usually be resumed 4-6 hours later if there are no signs of bleeding. The timing may need adjustment based on individual patient factors such as renal function, bleeding history, or the reason for anticoagulation. Patients should inform their healthcare provider about all medications they're taking, including over-the-counter drugs and supplements that might affect bleeding. The clinician performing the aspiration should apply firm pressure to the injection site after the procedure to minimize bleeding risk.
From the Research
Anticoagulation Management for Shoulder Aspiration
- The provided studies do not directly address the need to hold ASA 81 and tinzaparin 4500 prior to shoulder aspiration.
- However, a study on arthrocentesis and joint injection in patients receiving direct oral anticoagulants found that these procedures are safe and do not require withholding anticoagulation treatment before the procedure 2.
- Another study on the use of low-dose aspirin after shoulder arthroplasty found that routine use of low-dose ASA results in a very low risk of venous thromboembolism and medication-associated complications 3.
- Tinzaparin, a low-molecular-weight heparin, is effective for venous thromboembolism prophylaxis and treatment, and its use does not require dose adjustments in most patients 4.
- There is limited information on the specific management of ASA 81 and tinzaparin 4500 in the context of shoulder aspiration, and more research is needed to provide definitive guidance.