Hand surgery under vitamin K antagonist is acceptable under restrictions

Aim Confirm that hand surgery under ultrasound-guided peripheral nerve blocks with patient receving uninterrupted vitamin K antagonist (VKA) is reasonable if the International Normalized Ratio (INR) is under 3. Methods A monocentric restrospective study included adult patients in emergency (FESUM center) or scheduled hand surgery, between January 2013 to December 2015. Inclusion criteria was receving uninterrupted VKA (no restriction of age or indication of VKA). INR not older than 24 hours under 3 was expected. Exclusion criteria were ones over 3. Surgical and axillary-anesthesia complications were recorded, breging together bleeding, nervous signs, infection. We collected data in postoperative visits at 7th, 15th and 31st days and 6 months after the surgery. Results Eighty-nine patients (average age 74,34 years) for 100 procedures were included. VKA proportion was fluidione for 70%, warfarine for 29%, acenocoumarol for 1% including various indications (primarily for ACFA and DVT PE). An INR was controlled from 1.07 to 3 (average 2,31). One patient presented a bleeding complication. An hematoma in the surgical site who did not require reoperation. An extent of ecchymosis from the surgical incision is common in this patients like it was already known. Conclusions Do not inturrupt VKA in hand surgery is not associated in this study with a significant risk of complication under brachial plexus block if the INR is under 3.