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Effect of routine clopidogrel use on bleeding complications after ultrasound-guided thoracentesis
Mohammad B Zalt1, Rabih I Bechara, Christopher Parks
1Emory University School of Medicine, Atlanta, GA 30322, USA. mohammad.b.zalt@emory.edu
Insights
Ultrasound-guided thoracentesis is safe for patients on clopidogrel therapy. This procedure for symptomatic pleural effusion can be performed without discontinuing clopidogrel, showing no significant bleeding complications.
Area of Science:
- Medical procedures
- Cardiology
- Pulmonology
Background:
- Thoracentesis is a common medical procedure with a high safety record.
- Clopidogrel, an antiplatelet medication, is frequently used for cardiovascular disease prevention.
- Concerns exist regarding bleeding complications with clopidogrel during surgical procedures.
Purpose of the Study:
- To evaluate the safety of ultrasound (US)-guided thoracentesis in patients undergoing the procedure while on clopidogrel therapy.
- To determine the incidence of bleeding and other complications in this patient group.
Main Methods:
- A retrospective analysis of 30 consecutive patients receiving clopidogrel without other coagulation issues.
- 45 US-guided thoracenteses were performed over 26 months.
- Clopidogrel was not interrupted prior to thoracentesis in patients with symptomatic pleural effusion.
Main Results:
- No significant bleeding or other complications were observed in the 30 patients who underwent 45 thoracenteses.
- None of the patients required blood transfusions post-procedure.
- The study included patients presenting with respiratory distress due to pleural effusion.
Conclusions:
- US-guided thoracentesis can be safely performed in patients on clopidogrel therapy presenting with symptomatic pleural effusion.
- Interrupting clopidogrel treatment before the procedure is not necessary in this context.
- Larger studies are recommended to validate these findings.
Background:
Thoracentesis is one of the most commonly performed medical procedures with an excellent safety profile. Clopidogrel (a compound that inhibits adenosine diphosphate-induced platelet aggregation) is often prescribed for primary or secondary prevention of cardiovascular disease and has been associated with bleeding complications in patients undergoing surgical procedures. The purpose of this study was to assess the safety of ultrasound (US)-guided thoracentesis in patients receiving clopidogrel therapy.
Methods:
Data were collected on 30 consecutive patients taking clopidogrel without other known underlying coagulation problems. These patients underwent 45 US-guided thoracenteses over 26 months. Clopidogrel was not discontinued before the thoracentesis in patients presenting with symptomatic pleural effusion. Thoracenteses were performed in these patients and the incidence of bleeding and other complications among patients was reported.
Results:
Between June 2009 and August 2011, there were 30 consecutive patients on clopidogrel at the time of thoracenteses. These patients presented with respiratory distress because of pleural effusion and underwent a total of 45 thoracenteses. There was no significant bleeding or other complications in this patient population. No patient required transfusion after the procedure.
Conclusion:
Patients who are receiving clopidogrel and present with symptomatic pleural effusion can safely undergo US-guided thoracentesis without interrupting clopidogrel before the procedure. Larger studies are required to confirm these results.
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