Until recently, the safety of joint aspiration or injection in patients on anticoagulation was based on studies with warfarin , which reported only a small risk of increased bleeding. The first study to provide data on the risk of bleeding in patients on direct oral anticoagulants (DOACs) undergoing joint aspiration or injection is a retrospective review of 1050 consecutive procedures from Mayo Clinic over a six-year period [ 13 ]. There were no bleeding complications during the median follow-up period of five days. Of the 1050 procedures, 22 percent were performed in patients receiving a DOAC plus aspirin , and 1 percent were performed in patients on a DOAC plus clopidogrel . These findings support the safety of arthrocentesis and joint injection in patients receiving uninterrupted DOACs and/or antiplatelet therapy. (See "Joint aspiration or injection in adults: Technique and indications", section on 'Approach to the patient on anticoagulants' .)
Figure A shows a lytic destructive lesion in the vertebral body. Figure B shows multiple plasma cells. Multiple myeloma is a neoplastic process involving the proliferation of plasma cells. It is often associated with anemia, chronic pain, low-grade fevers, and skeletal lesions that are often "cold" on bone scans.
Weber showed that the main differential diagnosis for a patient older than 40 with a destructive bone lesion should include metastatic bone disease, multiple myeloma, lymphoma, and, less commonly, primary bone tumors.