title: Survey of Botulinum Toxin Injections in Anticoagulated Patients: Korean Physiatrists' Preference in Controlling Anticoagulation Profile Prior to Intramuscular Injection.
abstract: OBJECTIVE
  To evaluate Korean physiatrists' practice of performing intramuscular botulinum toxin injection in anticoagulated patients and to assess their preference in controlling the bleeding risk before injection.
  
  
  METHODS
  As part of an international collaboration survey study, a questionnaire survey was administered to 100 Korean physiatrists. Physiatrists were asked about their level of experience with botulinum toxin injection, the safe international normalized ratio range in anticoagulated patients undergoing injection, their tendency for injecting into deep muscles, and their experience of bleeding complications.
  
  
  RESULTS
  International normalized ratio <2.0 was perceived as an ideal range for performing Botulinum toxin injection by 41% of the respondents. Thirty-six respondents replied that the international normalized ratio should be lowered to sub-therapeutic levels before injection, and 18% of the respondents reported that anticoagulants should be intentionally withheld and discontinued prior to injection. In addition, 20%-30% of the respondents answered that they were uncertain whether they should perform the injection regardless of the international normalized ratio values. About 69% of the respondents replied that they did have any standardized protocols for performing botulinum toxin injection in patients using anticoagulants. Only 1 physiatrist replied that he had encountered a case of compartment syndrome.
  
  
  CONCLUSIONS
  In accordance with the lack of consensus in performing intramuscular botulinum toxin injection in anticoagulated patients, our survey shows a wide range of practices among many Korean physiatrists; they tend to avoid botulinum toxin injection in anticoagulated patients and are uncertain about how to approach these patients. The results of this study emphasize the need for formulating a proper international consensus on botulinum toxin injection management in anticoagulated patients.
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Jang
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Geun-Young
authors.initials: GY
authors.lastname: Park
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jihye
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Asayeon
authors.initials: A
authors.lastname: Choi
authors.affiliation: Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea.; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Soo Yeon
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada.; Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Boulias
authors.affiliation: Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada.; Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Canada.; Faculty of Health, York University, Toronto, Canada.
authors.forename: Chetan P
authors.initials: CP
authors.lastname: Phadke
authors.affiliation: Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada.; Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Farooq
authors.initials: F
authors.lastname: Ismail
authors.affiliation: Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sun
authors.initials: S
authors.lastname: Im
keywords: Anticoagulants; Botulinum toxins; International normalized ratio; Intramuscular injections