Abstract
Introduction: When pleural procedures (PP) are required in patients receiving antiplatelet therapy (APT), the risk of bleeding with APT continuation must be balanced against the risk of arterial thrombosis with APT withdrawal. Currently, the bleeding risk of PP in patients with APT is unknown.
Objectives: The study aimed at assessing the incidence of bleeding events (BE) after PP in patients receiving APT in comparison with controls.
Methods: A prospective multicentric study was conducted in 18 respiratory care departments and 11 medical intensive care units. The occurrence of BE was considered within the 24 hours following PP performance.
Results: 1133 PP were recorded: 130 (12%) blind pleural biopsies, 625 (55%) chest tube insertions, 378 (33%) thoracocentesis in 185 APT+ and 948 APT- subjects. APT+ subjects were more frequently males (89% vs 64%; p=0.02) and were older (73±13 vs 58±19 years; p<0.001) than APT- subjects.
In the APT+ group, there was a higher prevalence of renal failure (42% vs 23%; p<0,001) and ultrasound guidance (78% vs 68%; p=0,007) and a lesser prevalence of thrombopenia, i.e. platelet count below 100 G/L (7.5% vs 2%; p=0.006) in comparison with controls. There was no between groups difference concerning vitamin K antagonist and heparin therapies and operator's experience and qualification. 13 BE occurred: 9 hemothorax, 2 hemoptysis and 2 hematomas. The incidence of BE was higher in APT+ compared to APT- subjects (2.7% vs 0.8%; p=0.03; OR=3.3 95% CI [1.05-10.09]).
Conclusion: In this study, APT was associated with a 3 folds increase in PP-related bleeding risk.
- Copyright ©ERS 2015
