The Safety of Hand Surgery in the Anticoagulated Patient

Status Completed

Clinical Trial Summary

If operating on the anticoagulated patient has been safe for one of the investigators' surgeons for the past 10 years then providing prospective data that substantiates this could prevent complications related to the discontinuation of anticoagulation for hand surgery patients in the future.

Clinical Trial Description

All eligible patients will be offered study enrollment pre-operatively. Demographic data collected during clinical interaction that will be gathered for research purposes and will included patient height, weight, age, anticoagulant medication(s) used with dosage/duration of use, indication for anticoagulant medication, and current INR if on warfarin. Preoperative examination will include measures of 2 point discrimination in the digits, distance of the fingertips from the distal palmar crease upon flexion, and the patient-based outcome surveys that are to be collected after surgery (Quick DASH, SF-12, Visual Analog Scales pain/swelling). These patients will then undergo the appropriate surgical procedure without discontinuing their anticoagulant medication.

To ensure that patients are not being placed at increased risk, this study's protocol will not alter the surgical practices of the attending surgeons involved. Specifically, all surgeons perform their hand and wrist surgery under tourniquet control but differ in whether the tourniquet is deflated prior to wound closure. Each surgeon will be free to manage the tourniquet as they feel appropriate. The placement of would drains will remain at the discretion of the attending surgeon on a case-by-case basis.

Local anesthetics may be injected but none will be mixed with epinephrine.

Procedures: (if applicable) Obtaining pre-operative INR values when appropriate, and performing surgery while continuing anticoagulants is already standard care for one faculty member. All post-operative care except the completion of the Quick DASH and Short Form 12, and visual analog ratings is part of standard clinical care. Research questionnaires should take no more than 20 minutes to complete per visit. ;

Study Design

Observational Model: Case Control, Time Perspective: Prospective

Related Conditions & MeSH terms

Hand Surgery

Clinical Trial Details

NCT number	NCT00954928
Study type	Observational
Source	Washington University School of Medicine
Contact
Status	Completed
Phase	N/A
Start date	June 2009
Completion date	June 2015

View Details

See also
Status	Clinical Trial	Phase
Recruiting	`NCT03512223` - Intravenous and Perineural Dexamethasone for Brachial Plexus Block in Hand Surgery	Early Phase 1
Enrolling by invitation	`NCT04656834` - Hand Incision Study
Enrolling by invitation	`NCT04636463` - Music in Wide Awake Hand Surgery	N/A
Completed	`NCT05343299` - Postoperative Experience of 2 WALANT-type Modes of Anesthesia Used in Ambulatory Surgery of the Upper Limb.	Phase 1
Completed	`NCT00321425` - Ultrasound Guidance Vs. Electrical Nerve Stimulation for Infraclavicular Brachial Plexus Block	N/A
Completed	`NCT02209246` - The Effect of Feedback Regarding Illness Behavior on Patient Satisfaction in Hand Surgery	N/A
Completed	`NCT00956683` - Dual Endpoint Nerve Stimulation Versus Ultrasound in Infraclavicular Block for Hand Surgery	N/A
Completed	`NCT04491656` - Evaluating Clinical Outcomes for Determining the Optimal Delay to Skin Incision Under WALANT	N/A
Terminated	`NCT00827658` - Ulnar Nerve Block for Procedural Anesthesia - Wrist Versus Palm	N/A
Recruiting	`NCT04306666` - Early Rehabilitation After Hand or Wrist Ambulatory Surgery : How to Preserve Locomotion at Home Without Rebound Pain?
Completed	`NCT04189198` - A Comparison of 4% Articaine Versus 0.5%Bupivacaine for Ambulatory Surgery Under Supraclavicular Block	Phase 1
Completed	`NCT00699244` - Comparison of Central Versus Peripheral Placement of Local Anesthetic	N/A
Active, not recruiting	`NCT02073383` - Three Techniques for Ultrasound Guided Axillary Brachial Plexus Block	N/A
Completed	`NCT03632304` - Local Anesthesia With Minimal Sedation and Brachial Plexus Block in Hand Surgery	N/A
Completed	`NCT05325372` - A Comparative Study Between Infraclavicular and Axillary Blocks for Assessment of Motor Power Using Handgrip Dynamometer	N/A

Clinical trials are conducted in a series of steps, called phases - each phase is designed to answer a separate research question.

Phase 1: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
Phase 2: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.
Phase 3: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
Phase 4: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.