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[Fibreoptic bronchoscopy and anti-platelet agents: a risk-benefit analysis]
V Trosini-Désert1, J M Vergnon, J P Collet
1Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Pneumologie et Réanimation, Paris, France. valery.trosini-desert@psl.aphp/fr
Introduction:
Respiratory physicians are confronted increasingly often by patients, in whom a fibreoptic bronchoscopy (FB) is planned, who are taking anti-platelet agents (APAs) prescribed by their cardiologist. It is necessary therefore to weigh the indications for bronchoscopy and the subsequent benefits against the risks, not only of haemorrhage, but of thrombosis if the APAs are withdrawn.
Methods/Results:
In the absence of agreed guidelines on the subject this article reviews the literature and reports the results of a survey conducted among 138 members of the French Respiratory Endoscopy Group. Five questions were considered: 1) what is the risk of haemorrhage during the procedure? 2) what are the pharmacological characteristics of current APAs? 3) what is the risk of thrombosis on withdrawal of APAs? 4) what are the circumstances in which the FB may be delayed? 5) what should be the therapeutic strategy if the APAs are withdrawn?
Conclusions:
While awaiting clinical studies that will allow a better understanding of these questions, and the subsequent publication of practice guidelines, it is crucial that respiratory physicians are aware of the need, prior to FB, to inquire routinely about treatment with APAs, to identify the indication, and never to interrupt such treatment without consulting the prescriber.
