Should We Stop Oral Anticoagulants in the Surgical Treatment of Carpal Tunnel Syndrome?

Abstract

Introduction

It is usual to stop the intake of oral anticoagulants (anti-vitamin K) before surgery. Some authors have shown that during minimal surgery, the relay with low molecular weight heparin (LMWH) may lead to more thromboembolic complications. We present a prospective comparative study while evaluating the results of stopping or continuing anticoagulants in the surgery for carpal tunnel syndrome.

Material and methods

Our series included 21 patients (24 hands) taking anticoagulants on a long-term basis. For the first nine patients (group I), treatment with anticoagulants was stopped before the surgery. For the following 12 patients (group II), treatment with anticoagulants was not interrupted. The evaluation was based on the measurement of pain (VAS), functional score of the Quick D.A.S.H. and grip strength (Jamar®) and search for a haematoma or thromboembolism).

Results

The pain decreased by 3.5 points in both groups. The Quick D.A.S.H. decreased by 19.9 and 27.7 points in groups I and II, respectively. The average grip strength decreased by 2.5 kg in group I and increased by 3.8 kg in group II. A subcutaneous haematoma that got healed by itself was observed in group II. We did not observe any thromboembolic complications.

Discussion

In conclusion, it seems pointless to stop anticoagulants before surgical treatment of carpal tunnel. The first reason is that continuing anticoagulants does not result in a bleeding risk. The second reason is that this approach removes the theoretical risk of thromboembolic complications during a poorly monitored relay.