Acupuncture safety in patients receiving anticoagulants: a systematic review

Mcculloch, M.

Nachat, A.

Schwartz, J.

Casella-Gordon, V.

Cook, J.

Perm J

2015

19(1)

68-73

Systematic Review

Systematic Review

Hemorrhage

Cardiovascular Diseases

Safety

Anticoagulated Patients

Bleeding

Bleeding Complications

Acupuncture

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.

10.7812/TPP/14-057

Date of Input: 4/7/2015; Date Modified: 5/7/2015; Availability: --In File--; Priority: Normal; Hemorrhage; 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, USA. Email: michael.f.mcculloch@kp.org; eng; Web: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=25432001

Cardiovascular Diseases

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