Boulias, C., Ismail, F., Phadke, C. P., Bagg, S., Bureau, I., Charest, S., Chen, R., Cheng, A., Ethans, K., Fink, M., Finlayson, H., Gulasingam, S., Guo, M., Haziza, M., Hosseini, H., Khan, O., Lang, M., Lapp, T., Leckey, R., ... Winston, P. (2018). A Delphi-Based Consensus Statement on the Management of Anticoagulated Patients With Botulinum Toxin for Limb Spasticity. Archives of Physical Medicine and Rehabilitation, 99(11), 2183-2189. https://doi.org/10.1016/j.apmr.2018.04.023
Boulias, C, Ismail, F, Phadke, CP, Bagg, S, Bureau, I, Charest, S, Chen, R, Cheng, A, Ethans, K, Fink, M, Finlayson, H, Gulasingam, S, Guo, M, Haziza, M, Hosseini, H, Khan, O, Lang, M, Lapp, T, Leckey, R, Li Pi Shan, R, Liem, N, Lo, A, Mason, M, McNeil, S, McVeigh, S, Miller, T, Mills, PB, Naud, P, O'Connell, C, Petitclerc, M, Prevost, J, Reebye, R, Richardson, D, Satkunam, L, Sharma, S, Short, C, Sirois, G, Unarket, M, Wein, T, Wilkins, K & Winston, P 2018, 'A Delphi-Based Consensus Statement on the Management of Anticoagulated Patients With Botulinum Toxin for Limb Spasticity', Archives of Physical Medicine and Rehabilitation, vol. 99, no. 11, pp. 2183-2189. https://doi.org/10.1016/j.apmr.2018.04.023
@article{b4cd1f07c42a44e7b8acd82dce9de995,
title = "A Delphi-Based Consensus Statement on the Management of Anticoagulated Patients With Botulinum Toxin for Limb Spasticity",
abstract = "Objective: To create a consensus statement on the considerations for treatment of anticoagulated patients with botulinum toxin A (BoNTA) intramuscular injections for limb spasticity. Design: We used the Delphi method. Setting: A multiquestion electronic survey. Participants: Canadian physicians (N=39) who use BoNTA injections for spasticity management in their practice. Interventions: After the survey was sent, there were e-mail discussions to facilitate an understanding of the issues underlying the responses. Consensus for each question was reached when agreement level was ≥75%. Main Outcome Measures: Not applicable. Results: When injecting BoNTA in anticoagulated patients: (1) BoNTA injections should not be withheld regardless of muscles injected; (2) a 25G or smaller size needle should be used when injecting into the deep leg compartment muscles; (3) international normalized ratio (INR) level should be ≤3.5 when injecting the deep leg compartment muscles; (4) if there are clinical concerns such as history of a fluctuating INR, recent bleeding, excessive or new bruising, then an INR value on the day of injection with point-of-care testing or within the preceding 2-3 days should be taken into consideration when injecting deep compartment muscles; (5) the concern regarding bleeding when using direct oral anticoagulants (DOACs) should be the same as with warfarin (when INR is in the therapeutic range); (6) the dose and scheduling of DOACs should not be altered for the purpose of minimizing the risk of bleeding prior to BoNTA injections. Conclusions: These consensus statements provide a framework for physicians to consider when injecting BoNTA for spasticity in anticoagulated patients. These consensus statements are not strict guidelines or decision-making steps, but rather an effort to generate common understanding in the absence of evidence in the literature.",
author = "Chris Boulias and Farooq Ismail and Phadke, {Chetan P.} and Stephen Bagg and Isabelle Bureau and Stephane Charest and Robert Chen and Albert Cheng and Karen Ethans and Milo Fink and Heather Finlayson and Sivakumar Gulasingam and Meiqi Guo and Muriel Haziza and Hossein Hosseini and Omar Khan and Michael Lang and Timothy Lapp and Robert Leckey and {Li Pi Shan}, Rodney and Nathania Liem and Alexander Lo and Mark Mason and Stephen McNeil and Sonja McVeigh and Thomas Miller and Mills, {Patricia B.} and Pierre Naud and Colleen O'Connell and Marc Petitclerc and Julie Prevost and Rajiv Reebye and Denyse Richardson and Lalith Satkunam and Satyendra Sharma and Christine Short and Genevieve Sirois and Milan Unarket and Theodore Wein and Kathryn Wilkins and Paul Winston",
note = "Funding Information: Disclosures: Chris Boulias, Farooq Ismail, Chetan P Phadke, Robert Chen, Muriel Haziza, Kathryn Wilkins, Thomas Miller, Mark Mason, Lalith Satkunam, Christine Short, Genevieve Sirois, Theodore Wein, and Pierre Naud received funding (research grants, speaker fees, or honoraria) from Allergan; Chetan P Phadke, Farooq Ismail, Chris Boulias, Robert Chen, Muriel Haziza, Mark Mason, Lalith Satkunam, Christine Short, and Genevieve Sirois from Merz; Colleen O{\textquoteright}Connell, Mark Mason, Lalith Satkunam, Genevieve Sirois, Theodore Wein, and Pierre Naud from Ipsen; and Isabelle Bureau from Leo Pharma, Pfizer Canada, and Sanofi. The other authors have nothing to disclose. Publisher Copyright: {\textcopyright} 2018 American Congress of Rehabilitation Medicine",
year = "2018",
month = nov,
doi = "10.1016/j.apmr.2018.04.023",
language = "English",
volume = "99",
pages = "2183--2189",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",
number = "11",
}
TY - JOUR
T1 - A Delphi-Based Consensus Statement on the Management of Anticoagulated Patients With Botulinum Toxin for Limb Spasticity
AU - Boulias, Chris
AU - Ismail, Farooq
AU - Phadke, Chetan P.
AU - Bagg, Stephen
AU - Bureau, Isabelle
AU - Charest, Stephane
AU - Chen, Robert
AU - Cheng, Albert
AU - Ethans, Karen
AU - Fink, Milo
AU - Finlayson, Heather
AU - Gulasingam, Sivakumar
AU - Guo, Meiqi
AU - Haziza, Muriel
AU - Hosseini, Hossein
AU - Khan, Omar
AU - Lang, Michael
AU - Lapp, Timothy
AU - Leckey, Robert
AU - Li Pi Shan, Rodney
AU - Liem, Nathania
AU - Lo, Alexander
AU - Mason, Mark
AU - McNeil, Stephen
AU - McVeigh, Sonja
AU - Miller, Thomas
AU - Mills, Patricia B.
AU - Naud, Pierre
AU - O'Connell, Colleen
AU - Petitclerc, Marc
AU - Prevost, Julie
AU - Reebye, Rajiv
AU - Richardson, Denyse
AU - Satkunam, Lalith
AU - Sharma, Satyendra
AU - Short, Christine
AU - Sirois, Genevieve
AU - Unarket, Milan
AU - Wein, Theodore
AU - Wilkins, Kathryn
AU - Winston, Paul
N1 - Funding Information:
Disclosures: Chris Boulias, Farooq Ismail, Chetan P Phadke, Robert Chen, Muriel Haziza, Kathryn Wilkins, Thomas Miller, Mark Mason, Lalith Satkunam, Christine Short, Genevieve Sirois, Theodore Wein, and Pierre Naud received funding (research grants, speaker fees, or honoraria) from Allergan; Chetan P Phadke, Farooq Ismail, Chris Boulias, Robert Chen, Muriel Haziza, Mark Mason, Lalith Satkunam, Christine Short, and Genevieve Sirois from Merz; Colleen O’Connell, Mark Mason, Lalith Satkunam, Genevieve Sirois, Theodore Wein, and Pierre Naud from Ipsen; and Isabelle Bureau from Leo Pharma, Pfizer Canada, and Sanofi. The other authors have nothing to disclose.
Publisher Copyright:
© 2018 American Congress of Rehabilitation Medicine
PY - 2018/11
Y1 - 2018/11
N2 - Objective: To create a consensus statement on the considerations for treatment of anticoagulated patients with botulinum toxin A (BoNTA) intramuscular injections for limb spasticity. Design: We used the Delphi method. Setting: A multiquestion electronic survey. Participants: Canadian physicians (N=39) who use BoNTA injections for spasticity management in their practice. Interventions: After the survey was sent, there were e-mail discussions to facilitate an understanding of the issues underlying the responses. Consensus for each question was reached when agreement level was ≥75%. Main Outcome Measures: Not applicable. Results: When injecting BoNTA in anticoagulated patients: (1) BoNTA injections should not be withheld regardless of muscles injected; (2) a 25G or smaller size needle should be used when injecting into the deep leg compartment muscles; (3) international normalized ratio (INR) level should be ≤3.5 when injecting the deep leg compartment muscles; (4) if there are clinical concerns such as history of a fluctuating INR, recent bleeding, excessive or new bruising, then an INR value on the day of injection with point-of-care testing or within the preceding 2-3 days should be taken into consideration when injecting deep compartment muscles; (5) the concern regarding bleeding when using direct oral anticoagulants (DOACs) should be the same as with warfarin (when INR is in the therapeutic range); (6) the dose and scheduling of DOACs should not be altered for the purpose of minimizing the risk of bleeding prior to BoNTA injections. Conclusions: These consensus statements provide a framework for physicians to consider when injecting BoNTA for spasticity in anticoagulated patients. These consensus statements are not strict guidelines or decision-making steps, but rather an effort to generate common understanding in the absence of evidence in the literature.
AB - Objective: To create a consensus statement on the considerations for treatment of anticoagulated patients with botulinum toxin A (BoNTA) intramuscular injections for limb spasticity. Design: We used the Delphi method. Setting: A multiquestion electronic survey. Participants: Canadian physicians (N=39) who use BoNTA injections for spasticity management in their practice. Interventions: After the survey was sent, there were e-mail discussions to facilitate an understanding of the issues underlying the responses. Consensus for each question was reached when agreement level was ≥75%. Main Outcome Measures: Not applicable. Results: When injecting BoNTA in anticoagulated patients: (1) BoNTA injections should not be withheld regardless of muscles injected; (2) a 25G or smaller size needle should be used when injecting into the deep leg compartment muscles; (3) international normalized ratio (INR) level should be ≤3.5 when injecting the deep leg compartment muscles; (4) if there are clinical concerns such as history of a fluctuating INR, recent bleeding, excessive or new bruising, then an INR value on the day of injection with point-of-care testing or within the preceding 2-3 days should be taken into consideration when injecting deep compartment muscles; (5) the concern regarding bleeding when using direct oral anticoagulants (DOACs) should be the same as with warfarin (when INR is in the therapeutic range); (6) the dose and scheduling of DOACs should not be altered for the purpose of minimizing the risk of bleeding prior to BoNTA injections. Conclusions: These consensus statements provide a framework for physicians to consider when injecting BoNTA for spasticity in anticoagulated patients. These consensus statements are not strict guidelines or decision-making steps, but rather an effort to generate common understanding in the absence of evidence in the literature.
UR - http://www.scopus.com/inward/record.url?scp=85053009332&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85053009332&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2018.04.023
DO - 10.1016/j.apmr.2018.04.023
M3 - Article
C2 - 29803825
AN - SCOPUS:85053009332
SN - 0003-9993
VL - 99
SP - 2183
EP - 2189
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 11
ER -