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Effect of clopidogrel with and without aspirin on bleeding following transbronchial lung biopsy
Momen M Wahidi1, Robert Garland, David Feller-Kopman
1Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. wahid001@mc.duke.edu
Insights
Clopidogrel, an antiplatelet medication, does not increase bleeding risk during transbronchial lung biopsies (TBLB) in pigs, even when combined with aspirin. This finding is crucial for elderly patients with atherosclerotic disease undergoing such procedures.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Pharmacology
Background:
- Clopidogrel is widely used in elderly patients with atherosclerotic diseases.
- The risk of bleeding with clopidogrel during invasive pulmonary procedures is not well-established.
Purpose of the Study:
- To investigate the effect of clopidogrel, alone and with aspirin, on bleeding complications after transbronchial lung biopsy (TBLB).
Main Methods:
- Yorkshire pigs were randomized to receive clopidogrel or clopidogrel plus aspirin.
- Animals underwent flexible bronchoscopy with transbronchial lung biopsies.
- Blood loss following TBLB was measured to assess bleeding complications.
Main Results:
- No statistically significant difference in blood loss was observed between baseline and post-drug administration.
- Average blood collected after TBLB was 1.41 mL for clopidogrel and 1.75 mL for clopidogrel plus aspirin (p=0.42).
Conclusions:
- Clopidogrel, with or without aspirin, does not elevate bleeding risk following transbronchial lung biopsies in healthy pigs.
Background:
Clopidogrel, a potent inhibitor of platelet aggregation, is being commonly prescribed in the elderly population due to its benefits in patients with atherosclerotic diseases. It is currently unknown whether clopidogrel increases the risk of bleeding during invasive pulmonary procedures.
Methods:
Pigs of the Yorkshire species were randomized to one of the following two arms: clopidogrel (75 mg/d) alone; or clopidogrel plus aspirin (75 mg/d and 325 mg/d, respectively). The animals underwent flexible bronchoscopy with transbronchial lung biopsies under fluoroscopic guidance at baseline and after 1 week of daily oral intake of their assigned drugs. The main outcome of the study was the quantity of blood collected through the bronchoscope following transbronchial lung biopsy (TBLB).
Results:
Sixteen animals were enrolled in the study, with 8 animals randomized to each arm. No statistically significant difference was found in the average quantity of blood resulting from transbronchial lung biopsies between procedures performed at baseline and those performed after animals received either clopidogrel (mean [+/- SD] dose, 1.41 +/- 1.14 mL) or clopidogrel plus aspirin (mean dose, 1.75 +/- 1.28 mL; p = 0.42).
Conclusions:
Clopidogrel, with or without aspirin, does not increase bleeding complications after TBLB in healthy pigs.