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Ann Rehabil Med. 2016 Apr;40(2):279-287. English. Original Article.
Jang Y , Park GY , Park J , Choi A , Kim SY , Boulias C , Phadke CP , Ismail F , Im S .
Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada.
Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Canada.
Faculty of Health, York University, Toronto, Canada.

OBJECTIVE: To evaluate Korean physiatrists' practice of performing intramuscular botulinum toxin injection in anticoagulated patients and to assess their preference in controlling the bleeding risk before injection. METHODS: As part of an international collaboration survey study, a questionnaire survey was administered to 100 Korean physiatrists. Physiatrists were asked about their level of experience with botulinum toxin injection, the safe international normalized ratio range in anticoagulated patients undergoing injection, their tendency for injecting into deep muscles, and their experience of bleeding complications. RESULTS: International normalized ratio <2.0 was perceived as an ideal range for performing Botulinum toxin injection by 41% of the respondents. Thirty-six respondents replied that the international normalized ratio should be lowered to sub-therapeutic levels before injection, and 18% of the respondents reported that anticoagulants should be intentionally withheld and discontinued prior to injection. In addition, 20%-30% of the respondents answered that they were uncertain whether they should perform the injection regardless of the international normalized ratio values. About 69% of the respondents replied that they did have any standardized protocols for performing botulinum toxin injection in patients using anticoagulants. Only 1 physiatrist replied that he had encountered a case of compartment syndrome. CONCLUSION: In accordance with the lack of consensus in performing intramuscular botulinum toxin injection in anticoagulated patients, our survey shows a wide range of practices among many Korean physiatrists; they tend to avoid botulinum toxin injection in anticoagulated patients and are uncertain about how to approach these patients. The results of this study emphasize the need for formulating a proper international consensus on botulinum toxin injection management in anticoagulated patients.

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