Impact of Antithrombotic Drug Continuation on Postoperative Outcomes in Patients with Carpal Tunnel Syndrome: A Randomised, Open-Label, Parallel Group Trial

Background: To investigate the impact of antithrombotic drug continuation or interruption on postoperative outcomes in patients with carpal tunnel syndrome (CTS) who undergo endoscopic carpal tunnel release (ECTR). Methods: This prospective, randomised, open-label, parallel group trial was conducted between December 2016 and October 2022 of CTS patients on antithrombotic medications who underwent ECTR. The 65 participants were randomly assigned to either maintain antithrombotic therapy (continuation group, 34 patients) or suspend it (interruption group, 31 patients). The primary outcome was a version of the CTS Instrument developed by the Japanese Society for Surgery of the Hand (CTSI-JSSH). Secondary outcomes were the Semmes-Weinstein Monofilament Test (SW), swelling (determined by measuring the circumferences of the middle finger, wrist and hand), visual analogue scale (VAS) for pain, VAS for swelling evaluated independently by patients and doctors and complications. CTSI-JSSH was administered before surgery and 3 months after. SW was conducted before surgery and at 1 and 3 months after. Swelling was objectively measured before surgery and at 2 weeks and 1 month after. Both pain and swelling VAS scores were recorded at 2 weeks and 1 month postoperatively. Complications were evaluated up to 3 months postoperatively. Results: Results on the symptom severity scale (SSS) of the CTSI-JSSH were significantly better in the interruption group at 3 months after surgery. VAS swelling assessed by both patients and doctors was significantly lower in the interruption group. There were no complications in either group. Conclusions: The interruption group had better outcomes on the SSS and postoperative subjective swelling, with no cardiovascular events. For patients taking antithrombosis medication, short-term ECTR outcomes improve when its use is temporarily suspended. Level of Evidence: Level II (Therapeutic).