LIMITED RECOMMENDATION Two low quality studies provide limited evidence suggesting that anticoagulation medication may be safely continued for carpal tunnel release. Kaltenborn (2019) utilized propensity score matching to evaluate the association of bleeding complications with acetylsalicylic acid use in patients undergoing carpal tunnel release and demonstrated no difference in bleeding outcomes between the acetylsalicylic acid cohort and the control cohort. Brunetti (2013) similarly demonstrated no difference in complications between cohorts undergoing carpal tunnel release taking acetylsalicylic acid and those not taking acetylsalicylic acid. Although not included in the guideline given the lack of results specific to carpal tunnel syndrome, a single-center, prospective cohort trial (Bogunovic 2015) evaluated the impact of uninterrupted Warfarin use on hand and wrist surgery. When case matched to those not prescribed Warfarin, those prescribed Warfarin (with an INR<3.5) demonstrated an infrequent risk of bleeding complications requiring reoperation.
Benefits/Harms of Implementation
The benefits and harms of continuing anticoagulation vary based upon the indication for the specific anticoagulation. From a surgical perspective, the harm in continuing anticoagulation may include complications related to bleeding, however this has not been definitively demonstrated in the literature.
Cost Effectiveness/Resource Utilization
Continuation of anticoagulation medication may prevent unnecessary visits to a patient’s cardiologist and/or medical team to inquire and/or obtain counseling related to pausing or bridging medications.
Acceptability
Use of anticoagulants is accepted practice but may vary based upon type of anticoagulation, patient factors, and surgeon preference.
Feasibility
No issues related to feasibility beyond the anticipated discussion on risks of bleeding/hematoma when continuing on anticoagulation medication.
Future Research
Future research should be conducted to explore various types of anticoagulation and to increase the quality of evidence.
- Brunetti, S., Petri, G. J., Lucchina, S., Garavaglia, G., Fusetti, C.. (2013). Should aspirin be stopped before carpal tunnel surgery? A prospective study. World journal of orthopedics, 4(4), 299-302.
- Kaltenborn, A., Frey-Wille, S., Hoffmann, S., Wille, J., Schulze, C., Settje, A., Vogt, P. M., Gutcke, A., Ruettermann, M.. (2019). "The risk of complications after carpal tunnel release in patients taking acetylsalicylic acid as platelet inhibition - A multi-center propensity score-matched study". Plastic and Reconstructive Surgery, 0(0), . https://www.cochranelibrary.com/central/doi/10.1002/central/CN-02050606/full