Incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesis
Introduction Thoracentesis is one of the most commonly performed procedures in the inpatient setting. Although coagulation profile is usually evaluated prior to thoracentesis, bleeding is a rare complication, occurring in less than 1% of the cases. Several society guidelines recommend holding antipl...
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BMJ Publishing Group
2021-01-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/8/1/e000874.full |
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| author | Zaid Noori Lamia Aljundi Abdelkader Chaar Peter Boshara Aryan Shiari George Gennaoui Cristine Girard Suzan Szpunar Rene Franco-Elizondo |
| author_facet | Zaid Noori Lamia Aljundi Abdelkader Chaar Peter Boshara Aryan Shiari George Gennaoui Cristine Girard Suzan Szpunar Rene Franco-Elizondo |
| author_sort | Zaid Noori |
| collection | DOAJ |
| description | Introduction Thoracentesis is one of the most commonly performed procedures in the inpatient setting. Although coagulation profile is usually evaluated prior to thoracentesis, bleeding is a rare complication, occurring in less than 1% of the cases. Several society guidelines recommend holding antiplatelet medications and anticoagulants prior to thoracentesis. Clinical practice guidelines also recommend correcting international normalised ratios of more than two and platelet counts <50 X10∧9/L.Methods This is a retrospective descriptive study that included 292 patients who underwent thoracentesis in the inpatient setting at Ascension St John Hospital in Detroit, Michigan, USA from 2016 to 2018. We identified patients who had uncorrected risk for bleeding and collected data about their demographics, comorbidities, use of antiplatelet or anticoagulants and procedural details including complications. We looked for any postprocedural bleeding events to study their relation to the already established bleeding risk.Results Two hundred and ninety-two thoracenteses were performed, 95.5% (n=279) were performed by interventional radiology. Majority of patients were at risk of bleeding 83% (n=242). No bleeding events occurred. Medications that were not held prior to thoracentesis included: clopidogrel 11% (n=32), novel anticoagulants 8.2% (n=24) and unfractionated heparin 50% (n=146). Use of ultrasound guidance decreased the amount of haemoglobin decline from 1 to 2 g/L (p=0.029). Seventeen patients suffered pneumothorax, eight of which required intervention.Discussion Our study suggests that performing thoracentesis without correction of underlying coagulopathy may be safe. This may prevent consequences of holding essential medications and reduce the amount of blood products administered to patients in need of thoracentesis. |
| format | Article |
| id | doaj-art-ec3e4aad66094ef2a4a3b37ccccac57b |
| institution | Kabale University |
| issn | 2052-4439 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-ec3e4aad66094ef2a4a3b37ccccac57b2024-11-24T16:35:07ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392021-01-018110.1136/bmjresp-2021-000874Incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesisZaid Noori0Lamia Aljundi1Abdelkader Chaar2Peter Boshara3Aryan Shiari4George Gennaoui5Cristine Girard6Suzan Szpunar7Rene Franco-Elizondo8Internal Medicine, Ascension St John Hospital, Detroit, Michigan, USAInternal Medicine, Ascension St John Hospital, Detroit, Michigan, USAInternal Medicine, Ascension St John Hospital, Detroit, Michigan, USAInternal Medicine, Ascension St John Hospital, Detroit, Michigan, USAInternal Medicine, Ascension St John Hospital, Detroit, Michigan, USAInternal Medicine, Ascension St John Hospital, Detroit, Michigan, USASt George’s University, School of Medicine, West Indies, GrenadaMedical Education, Ascension St John Hospital, Detroit, Michigan, USAPulmonary, Critical Care and Sleep Medicine, Ascension St John Hospital, Detroit, Michigan, USAIntroduction Thoracentesis is one of the most commonly performed procedures in the inpatient setting. Although coagulation profile is usually evaluated prior to thoracentesis, bleeding is a rare complication, occurring in less than 1% of the cases. Several society guidelines recommend holding antiplatelet medications and anticoagulants prior to thoracentesis. Clinical practice guidelines also recommend correcting international normalised ratios of more than two and platelet counts <50 X10∧9/L.Methods This is a retrospective descriptive study that included 292 patients who underwent thoracentesis in the inpatient setting at Ascension St John Hospital in Detroit, Michigan, USA from 2016 to 2018. We identified patients who had uncorrected risk for bleeding and collected data about their demographics, comorbidities, use of antiplatelet or anticoagulants and procedural details including complications. We looked for any postprocedural bleeding events to study their relation to the already established bleeding risk.Results Two hundred and ninety-two thoracenteses were performed, 95.5% (n=279) were performed by interventional radiology. Majority of patients were at risk of bleeding 83% (n=242). No bleeding events occurred. Medications that were not held prior to thoracentesis included: clopidogrel 11% (n=32), novel anticoagulants 8.2% (n=24) and unfractionated heparin 50% (n=146). Use of ultrasound guidance decreased the amount of haemoglobin decline from 1 to 2 g/L (p=0.029). Seventeen patients suffered pneumothorax, eight of which required intervention.Discussion Our study suggests that performing thoracentesis without correction of underlying coagulopathy may be safe. This may prevent consequences of holding essential medications and reduce the amount of blood products administered to patients in need of thoracentesis.https://bmjopenrespres.bmj.com/content/8/1/e000874.full |
| spellingShingle | Zaid Noori Lamia Aljundi Abdelkader Chaar Peter Boshara Aryan Shiari George Gennaoui Cristine Girard Suzan Szpunar Rene Franco-Elizondo Incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesis BMJ Open Respiratory Research |
| title | Incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesis |
| title_full | Incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesis |
| title_fullStr | Incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesis |
| title_full_unstemmed | Incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesis |
| title_short | Incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesis |
| title_sort | incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesis |
| url | https://bmjopenrespres.bmj.com/content/8/1/e000874.full |
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