Need a joint injection? What about your blood thinner medication?
9/12/2024 by Terin Sytsma, M.D.
Anticoagulants are commonly referred to as "blood thinners" and are commonly used to treat and prevent blood clots and stroke. However, they can increase the risk of bruising and bleeding.
Common blood thinning medications include:
- Warfarin (Coumadin)
- Direct oral anticoagulants
- Dabigatran (Pradaxa)
- Rivaroxaban (Xarelto)
- Apixaban (Eliquis)
- Edoxaban (Lixiana)
- Anti-platelet medications
- Aspirin
- Clopidogrel (Plavix)
- Ticagrelor (Brilinta)
Joint injections can be an important treatment for many painful musculoskeletal conditions such as osteoarthritis, rheumatoid arthritis, trigger finger, gout, pseudogout, bursitis and tendinitis.
If you have been referred for a joint injection or aspiration, you may have questions about the safety of having these procedures while on blood thinners. However, there are also major risks of stopping blood thinners, including recurrent blood clots, stroke and death. You should not stop these medications without talking with your clinician.
The major bleeding risk of a joint aspiration/injection is bleeding into the joint, also known as a hemarthrosis. This risk is very low at less than 1 in 1000 injections. As long as your INR, a measurement used to determine how long it takes for your blood to clot, is in a therapeutic range while taking warfarin, or Coumadin, there is little, if any, increased risk of bleeding into the joint with a joint injection or aspiration. Similarly, taking direct oral anticoagulants and anti-platelet medications will not significantly increase your risk of bleeding into non-spine joints following one of these procedures. These recommendations do not apply to injections into the spine.
In summary, if you are on a blood thinning medication and need to undergo a non-spine joint injection or aspiration, you may have some extra bruising, but the risk of a major bleeding complication is minimal, and you should continue your medications. If you have questions, it is always best to contact your healthcare team.
Terin Sytsma, M.D., is a general internist in the Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical degree at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester, Minnesota. Her interests include office-based procedures and musculoskeletal medicine.