Spontaneous hemarthroses of large joints during continuous anticoagulant treatment (clinical cases)

Objective. Demonstration and analysis of clinical cases of spontaneous hemarthroses of degeneratively altered large joints due to prolonged use of direct anticoagulants.

Prospective observation of three patients aged 80 to 90 years who were treated at the 432nd Military Clinical Medical Center from 2020 to 2024 with a diagnosis of «spontaneous hemarthrosis of the shoulder joint on long-term anticoagulant treatment.» The advantages and disadvantages of anticoagulant therapy in the occurrence of hemarthroses of large joints were considered. The analysis of the provided traumatological care and subsequent adjustment of anticoagulant therapy was conducted. In all cases described in the study, the hemarthrosis had been treated after achieving adequate hemostasis, and the dosage of the administered anticoagulants was adjusted.

Conclusion. Spontaneous hemarthrosis is a characteristic complication that occurs with prolonged use of direct anticoagulants, which requires urgent qualified traumatological care. If spontaneous hemarthrosis occurs, it is possible to resume anticoagulant therapy only after a diagnostic and therapeutic joint puncture and achieving effective hemostasis. Treatment of spontaneous hemarthrosis in high risk of thrombosis requires a multidisciplinary approach, subsequent assessment of bleeding risk using the HAS-BLED scale, and monitoring of coagulogram.

1. Buryachkovskaya, L. I. Algoritmy i shkaly riska tromboza i krovotecheniya v kardiologii i nevrologii: prakticheskoe posobie / Buryachkovskaya, L. I. [i dr.]. – Moskva, 2018. – 104 c.

2. Dalrymple, J. Management of Haemarthrosis in Patients On Oral Anticoagulants / J. Dalrymple et al. // Geriatr. Orthop. Surg. Rehabil. – 2022. – Vol. 13. – P. 174–180.

3. Gerster, J. C. Hemarthroses complicating anticoagulant therapy (heparin, oral anticoagulants) // Schweiz. Med. Wochenschr. – 1977. – Vol. 107, № 33. – P. 1170–1172.

4. Wild, J. H. Hemarthrosis associated with sodium warfarin therapy / J. H. Wild, N. J. Zvaifler // Arthritis Rheum. – 1976. – Vol. 19, № 1. – P. 98–102.

5. L. Wirth, L. Cornelius P. Spontaneous haemarthrosis causing anterior shoulder dislocation / L. Wirth // Eur. J. Emerg. Med. – 2010. – Vol. 17, № 6. – P. 316–317.