To assess the safety of needle EMG in patients on newer oral anticoagulants (NOACs)  in comparison with warfarin.

EMG is useful in the diagnosis of neuromuscular and musculoskeletal conditions. However, the safety of EMG in patients on NOACs and the bleeding risk remains unknown.

We reviewed the records of patients who underwent EMG of both superficial and deep muscles and those who were on either on warfarin (INR 2-3) or NOACs (while still on them). All patients were monitored clinically and with ultrasound of deeper muscles for two hours post procedure. Patients were discharged with detailed written instructions on the complications and also the details of the nearby ER, in case there were any complications. A follow-up phone call was made 3 days after the procedure to assess for any complications that needed clinical intervention. 

58 patients were included - 29 on NOACs and 29 on warfarin. The mean age was 59.33 +/- 16 years, 30 were male. Rivaroxaban was used in 19 (63%), apixaban in 8 (27%) and dabigatran in 2 (10%). 361 muscles were tested of which 55(15.2%) were deep muscles. Hemorrhagic complications from needle EMG were noted in 11 patients - 9 (75%) NOACs and 2 (25%) warfarin. 6 had hemorrhagic complications with rivaroxaban, 2 with apixaban and 1 with dabigatran. Acute bleeding needing pressure bandage was seen in one (rivaroxaban), clinical hematoma requiring ice packs ( within 2 hrs) was seen in 5 (2 apixaban, 2 rivaroxaban, 1 warfarin), hematoma on ultrasound of deep muscles was seen in 2 (rivaroxaban).3 patients reported hematoma on follow up over the phone but none needed clinical intervention. There was no statistical significance (p=0.623) with hemorrhagic complications between the NAOC and warfarin.

Patients on NOACs had minimal risk of hemorrhagic complications and the risk is not significantly different from those on warfarin.