Intravesical Botulinum Toxin A Injections in patients on antiplatelet and anticoagulation therapy
BAUS ePoster online library. Mensah E. Jun 25, 2019; 259571; P7-7 Disclosure(s): Nil
Ms. Elsie Ellimah Mensah
Ms. Elsie Ellimah Mensah
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There is little evidence regarding the safety of Intravesical botulinum Toxin-A(Botox) injections in patients on anticoagulant/antiplatelet(AC/AP) medication. The cessation of which may predispose to thromboembolic or ischaemic events. We reviewed significant bleeding events after Botox injection with concurrent AC/AP use.
A retrospective review of all patients having Botox in 3 London hospitals was conducted between January 2016-July 2018 to examine those with continued AC/AP therapy. Demographic data, indication for injection, and significant bleeding requiring intervention were recorded.
532 patients had Botox injections during this time. 63 patients [mean age 69 years (range 19-89), had a total of 114 separate rounds of Botox injections whilst on treatment dose AC/AP therapy. Each patient had between 1-7 repeat Botox injections. AC/AP use included; aspirin 44, clopidogrel 37, warfarin 19, NOAC (novel/non-vitamin K oral anticoagulant) 14. Patients on warfarin all had INR < 3.
There was 1/114(0.88%) episode of post-injection haematuria requiring overnight admission resolving spontaneously. This patient, on rivaroxiban had 300U of Botox injected through 20 sites, on a background of previous prostate radiotherapy. There was no report of bladder washout or transfusion.
Very few significant bleeding events occurred despite continuation of AC/AP therapy. Some patients within this group may have other factors that further increase bleeding risk. This is an important consideration during patient counselling, and when treating patients who have high risk of thrombosis with AC/AP.
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