Thoracentesis and the risks for bleeding: a new era

Thoracentesis is a commonly performed procedure throughout the world. Convention dictates that patients should have laboratory values such as international normalized ratio (INR) and platelets corrected or medications that affect bleeding withheld prior to performing this procedure. By transfusing blood products or withholding medications, patients are exposed to risks that are different than but equally if not more significant than the risk of hemothorax from thoracentesis. This review highlights recent studies that suggest the parameters of performing thoracentesis should be less stringent than traditionally thought.

Although the safety of thoracentesis has improved with the use of ultrasound and other advancements, the number of patients on new medications that exert an influence on bleeding and those who have physiologic coagulation abnormalities continues to grow. Despite a 1991 study demonstrating the safety of thoracentesis in patients with an abnormal INR or low platelet count, transfusion of blood products to normalize laboratory values is commonplace. A number of studies within the past year address the safety of thoracentesis amidst INR and platelet abnormalities and in patients taking antiplatelet or other medications that affect a patient's bleeding potential.

Although large randomized studies do not exist, recent literature suggests that it is time to reevaluate the need to correct INR and platelet counts or to transfuse blood products or withhold medications prior to thoracentesis in patients felt to have a risk of possible bleeding.