Bleeding risk after acupuncture in patients taking anticoagulant drugs: A case control study based on real-world data

Abstract

Objectives: Patients on anticoagulant medications may be at a higher risk of bleeding after acupuncture. This study aimed to assess the association between anticoagulant drug use and bleeding after acupuncture.

Design: Case control study SETTING: We analysed the diagnosis and treatment records (2000-2018) of a random sample of two million patients from the National Health Insurance Research Database in Taiwan.

Interventions: anticoagulant and antiplatelet drugs MAIN OUTCOME MEASURES: The incidence rates of major (visceral bleeding or ruptured blood vessels requiring transfusion) and minor (skin bleeding or contusion) bleeding after acupuncture RESULTS: We included the records of 13,447,563 acupuncture sessions in 821,946 participants and followed up the patients for 14 days after each session. The incidence of minor bleeding was 8.31 per 10,000 needles, whereas that of major bleeding was 4.26 per 100,000 needles. Anticoagulants significantly increased the risk of minor bleeding (adjusted OR = 1.15 (1.03-1.28)), but the risk of major bleeding did not reach statistical significance (adjusted OR = 1.18 (0.8 0-1.75)). Anticoagulants, such as warfarin (adjusted OR = 4.95 (2.55-7.64)), direct oral anticoagulants (adjusted OR = 3.07 (1.23-5.47)), and heparin (adjusted OR = 3.72 (2.18-6.34)) significantly increased the risk of bleeding. However, antiplatelet drug was not significantly associated with post-acupuncture bleeding. Comorbidities including liver cirrhosis, diabetes, and coagulation defects, were the risk factors for bleeding after acupuncture.

Conclusions: Anticoagulant drugs may increase the risk of bleeding after acupuncture. We encourage physicians to ask patients in detail about their medical history and drug use prior to acupuncture treatment.

Keywords: Acupuncture; Anticoagulant drugs; Bleeding; Diabetes mellitus; Liver cirrhosis; Risk factors.