Treatment of Dupuytren Contracture With Collagenase Is Safe in the Anticoagulated Patient

Abstract

There is no financial information to disclose. It is safe to perform collagenase injections for the treatment of Dupuytren contracture in the anticoagulated patient. A retrospective review of all patients receiving collagenase injections for Dupuytren contracture by 2 surgeons between 2010 and 2017 was performed. Outcomes evaluated included demographics, type of anticoagulation, skin tear, tendon rupture, lymphadenopathy, sensory abnormality, hematoma, and bleeding. Statistical analysis included chi-square and Fisher exact tests. There were a total of 388 injections performed in 197 patients. Treated locations included the first web space (n = 4), thumb (n = 7), index (n = 11), middle (n = 47), ring (n = 104), and little fingers (n = 215). 77% of patients were male (n = 152), and 23% female (n = 45). Average age was 66 years. Average time to manipulation was 2.75 days. Average follow-up was 311 days. 10 patients did not receive manipulation owing to auto-rupture. Of the 388 procedures, 52% of the patients (n = 201) were anticoagulated. The majority were taking aspirin (91%, n = 182), followed by warfarin (13%, n = 27), clopidogrel (4%, n = 9), apixaban (4%, n = 8), rivaroxaban (2%, n = 4), and dabigatran (1%, n = 2). Several patients were taking multiple anticoagulants. There were 42 skin tears (11%): 21 in the anticoagulated group (10%) and 21 in the not-anticoagulated group (11%) (P = .80). 86% of the skin tears occurred in patients taking aspirin (n = 18), and 14% warfarin (n = 3). Subgroup analysis determined no significant difference for aspirin-related skin tears (P = .68) or warfarin-related skin tears (P = .99). There was one tendon rupture in the anticoagulated group (aspirin) and no tendon ruptures in the not-anticoagulated group (P = .34). Lymphadenopathy was present in 7 patients in the anticoagulated group (3%), and 11 patients in the not-anticoagulated group (6%) (P = .26). 71% of patients with lymphadenopathy were taking aspirin (n = 5), and 29% apixaban (n = 2). While not statistically significant, 25% of patients on apixaban had lymphadenopathy (2/8), compared with 2.8% of all other patients; greater power is required to determine if this was meaningful. No patients experienced sensory abnormalities, a hematoma requiring intervention, or uncontrollable bleeding. •Anticoagulation, particularly aspirin use, is commonly encountered by hand surgeons treating Dupuytren contracture.•There is no significant difference in complications in the anticoagulated patient versus the not-anticoagulated patient.•It is safe to perform collagenase injections for Dupuytren contracture in the anticoagulated patient, regardless of the type of anticoagulation.