Abstract
Many clinicians increasingly use dry needling in clinical practice. However, whether patients' intake of antithrombotic drugs should be considered as a contraindication for dry needling has not been investigated to date. As far as we know, there are no publications in analyzing the intake of antiplatelet or anticoagulant agents in the context of dry needling techniques. A thorough analysis of existing medications and how they may impact various needling approaches may contribute to improved evidence-informed clinical practice. The primary purpose of this paper is to review the current knowledge of antithrombotic therapy in the context of dry needling. In addition, reviewing guidelines of other needling approaches, such as electromyography, acupuncture, botulinum toxin infiltration, and neck ultrasound-guided fine-needle aspiration biopsy, may provide specific insights relevant for dry needling. Based on published data, taking antithrombotic medication should not be considered an absolute contraindication for dry needling techniques. As long as specific dry needling and individual risks are properly considered, it does not change the risk and safety profile of dry needling. Under specific circumstances, the use of ultrasound guidance is recommended when available.
Highlights
Worldwide, clinicians are using dry needling (DN) to reduce pain [1, 2], increase range of motion and flexibility [3], enhance performance [4], reduce spasticity [5], or improve fascial and scar tissue mobility [6, 7]
Patients taking antithrombotic drugs may have an increased risk of suffering bleeding complications when being treated with DN. e American Physical erapy Association recommends that “patients with an abnormal bleeding tendency must be needled with caution
Dry needling of deep muscles that cannot be approached with direct pressure to create hemostasis may need to be avoided to prevent excessive bleeding” [12]. e most common target of DN is trigger points, which are located in close proximity to endplate zones [13]
Summary
Clinicians are using dry needling (DN) to reduce pain [1, 2], increase range of motion and flexibility [3], enhance performance [4], reduce spasticity [5], or improve fascial and scar tissue mobility [6, 7]. Dry needling is used mostly by physiotherapists, but other disciplines have started to use DN, such as occupational therapy, athletic training, chiropractic, and acupuncture. Since these clinicians may not have a solid working knowledge of antithrombotic drugs and their specific risk factors, it is imperative to review the different kinds of antithrombotic drugs before reviewing guidelines from other procedures that use needles. UFH and LMWH are prescribed, along with dual antiplatelet therapy in patients with acute coronary syndrome (ACS) and they reduce VTE complications of highrisk medical conditions, such as heart failure or prolonged immobilization in bed, or in knee or hip arthroplasty [22].
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