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Perm J. 2015 Winter;19(1):68-73. doi: 10.7812/TPP/14-057. Epub 2014 Nov 24.

Acupuncture safety in patients receiving anticoagulants: a systematic review.

Author information

1
Research Lead for Integrative Medicine at the Walnut Creek Hospital in CA and a Research Chief at the Pine Street Foundation in San Anselmo, CA. michael.f.mcculloch@kp.org.
2
Director of Integrative Medicine at the Walnut Creek Hospital in CA. arian.nachat@kp.org.
3
Research Intern in Integrative Medicine at the Walnut Creek Hospital in CA. jjschwar@princeton.edu.
4
Clinical Nurse Specialist in Integrative Medicine at the Walnut Creek Hospital in CA. vicki.gordon@kp.org.
5
Research Intern in Integrative Medicine at the Walnut Creek Hospital in CA. cookjos1@yahoo.com.

Abstract

INTRODUCTION:

Theoretically, acupuncture in anticoagulated patients could increase bleeding risk. However, precise estimates of bleeding complication rates from acupuncture in anticoagulated patients have not been systematically examined.

OBJECTIVE:

To critically evaluate evidence for safety of acupuncture in anticoagulated patients.

METHODS:

We searched PubMed, EMBASE, the Physiotherapy Evidence Database, and Google Scholar.

RESULTS:

Of 39 potentially relevant citations, 11 met inclusion criteria: 2 randomized trials, 4 case series, and 5 case reports. Seven provided reporting quality sufficient to assess acupuncture safety in 384 anticoagulated patients (3974 treatments). Minor-moderate bleeding related to acupuncture in an anticoagulated patient occurred in one case: a large hip hematoma, managed with vitamin K reversal and warfarin discontinuation following reevaluation of its medical justification. Blood-spot bleeding, typical for any needling/injection and controlled with pressure/cotton, occurred in 51 (14.6%) of 350 treatments among a case series of 229 patients. Bleeding deemed unrelated to acupuncture during anticoagulation, and more likely resulting from inappropriately deep needling damaging tissue or from complex anticoagulation regimens, occurred in 5 patients. No bleeding was reported in 2 studies (74 anticoagulated patients): 1 case report and 1 randomized trial prospectively monitoring acupuncture-associated bleeding as an explicit end point. Altogether, 1 moderate bleeding event occurred in 3974 treatments (0.003%).

CONCLUSION:

Acupuncture appears to be safe in anticoagulated patients, assuming appropriate needling location and depth. The observed 0.003% complication rate is lower than the previously reported 12.3% following hip/knee replacement in a randomized trial of 27,360 anticoagulated patients, and 6% following acupuncture in a prospective study of 229,230 all-type patients. Prospective trials would help confirm our findings.

PMID:
25432001
PMCID:
PMC4315381
DOI:
10.7812/TPP/14-057
[Indexed for MEDLINE]
Free PMC Article

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