Acupuncture-Induced Intramuscular Hematoma in Patients Taking Anticoagulation Drugs: An Emerging Clinical Entity

BACKGROUND:Oral anticoagulation is used extensively for prevention of thromboembolic events. Whether acupuncture is safe for patients taking anticoagulants is not clear.OBJECTIVE: To describe a patient with a history of ischemic stroke and paroxysmal nonvalvular atrial fibrillation who was in stroke rehabilitation including acupuncture.DESIGN/SETTING/PATIENT:The patient developed sudden calf hematoma when optimal therapeutic intensity of international normalized ratio (INR) was achieved.RESULTS:This patient was treated conservatively, without symptoms of compartment syndrome, and calf hematomas were resolved in 3 months.CONCLUSIONS:With increased acceptance of acupuncture worldwide and enforcement of clinical guidelines for prevention of thromboembolism, acupuncture-induced hematoma will be an emerging clinical entity. To minimize hemorrhagic complications, caution should be exercised when patients receiving oral anticoagulation request acupuncture treatment.