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Objective: In the absence of national or international guidelines, physician approaches to administer botulinum toxin (BTX) injections in patients on an anticoagulant therapy may be variable. We aimed to document the preferences and attitudes of physicians for controlling the bleeding risk of BTX injections in anticoagulated patients. Material and Methods: An electronic survey of physicians across Turkey who practice BTX administration for spasticity management was conducted. Results: In total, 80 physicians participated in the survey. There was a wide variance regarding the type of guidance and needle they used for injecting BTX in their routine practice. Among the respondents, only 7% reported refusing to administer BTX injections in anticoagulated patients, whereas 4% reported performing the injections without controlling the International Normalized Ratio (INR) value. Of the remaining respondents, the safe INR value for BTX injections was reported as ≤2.0 by 45%, ≤2.5 by 38%, and ≤3.0 by 17% respondents. Most of the physicians reported altering some portion of their routine injection technique in anticoagulated patients. Conclusion: A majority of physicians remain cautious and restrict the administration of BTX in some way for anticoagulated patients. Future studies are required to establish a safe INR value and to develop a consensus statement for BTX injections in this patient population.

Approaches of Physicians across Turkey to Administer Botulinum Toxin Injections in Anticoagulated Patients