Ultrasound-Guided Thoracentesis Appears Safe With Novel Oral Anticoagulants or Clopidogrel

By Will Boggs MD

August 06, 2019

NEW YORK (Reuters Health) - Rates of significant bleeding complications are very low after ultrasound-guided thoracentesis in patients on novel oral anticoagulants (NOACs) and/or clopidogrel, a retrospective analysis found.

As reported in Mayo Clinic Proceedings, online July 11, Dr. Priya P. Patel and colleagues from Mayo Clinic, in Rochester, Minnesota, evaluated the risk of hemorrhagic complications after 115 ultrasound-guided thoracenteses in 103 patients, 43 of whom were taking a NOAC and 69 of whom were taking clopidogrel.

All patients used their medication within 24 hours of the procedure and continued using it daily after the procedure.

Additional bleeding risk factors were common: 45.2% of procedures had at least two bleeding risk factors (including the drug), and 11.3% had at least three or more.

The mean decrease in hemoglobin during the 48 hours after thoracentesis was 0.24 g/dL (0.39 g/dL in the NOAC group and 0.17 g/dL in the clopidogrel group). No patient had a hemoglobin decrease of greater than 2 g/dL.

There were no bleeding complications in any patient.

"The overall risk of significant hemorrhage in patients taking an NOAC and/or clopidogrel while undergoing ultrasound-guided thoracentesis is very low," the authors conclude. "Albeit the total number of procedures reviewed may be insufficient to prove definitive safety, it is sufficient to provide a measure of relative risk when assessing benefits of thoracentesis in these patients."

Dr. Jonathan T. Puchalski of Yale University School of Medicine and Yale-New Haven Hospital, in New Haven, Connecticut, who previously reported that thoracentesis appears safe in patients with uncorrected bleeding risk, told Reuters Health by email, "Although more data is needed, there is a growing body of evidence that suggests thoracentesis is safe in patients taking some oral anticoagulants. Despite the fear of 'bleeding risks,' bleeding rarely occurs with this procedure."

"Many physicians are reluctant to perform thoracentesis for fear of bleeding and often withhold the medication for up to a week," said Dr. Puchalski, who was not involved in the new work. "It is typically impractical to hold the medication this long in patients with symptoms from the effusion or in need of more urgent evaluation."

Dr. Patel did not respond to a request for comments.

SOURCE: https://mayocl.in/31kobxm

Mayo Clinic Proc 2019.