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EBUS-TBNA and EUS-FNA: Risk Assessment for Patients Receiving Clopidogrel
Nikhil Meena1, Wissam Abouzgheib, Setu Patolia
1*Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR †Division of Pulmonary and Critical Care Medicine, Cooper Medical School at Rowan University, Cooper, Camden, NJ ‡Division of Pulmonary, Critical Care & Sleep Medicine, St. Louis University School of Medicine, St. Louis, MO.
Insights
Patients taking clopidogrel can safely undergo endobronchial ultrasound (EBUS) or esophageal ultrasound (EUS) guided biopsies. This study found no significant bleeding complications in patients on clopidogrel during these procedures.
Area of Science:
- Cardiology
- Pulmonology
- Gastroenterology
Background:
- Clopidogrel is a critical antiplatelet medication for preventing thrombotic events.
- Bleeding is the primary toxicity associated with clopidogrel therapy.
- Managing clopidogrel in patients undergoing invasive procedures requires careful consideration.
Purpose of the Study:
- To assess the bleeding risk associated with endobronchial ultrasound (EBUS) or esophageal ultrasound (EUS) guided needle aspiration biopsy in patients taking clopidogrel.
Main Methods:
- A retrospective review of 395 consecutive EBUS-TBNA and EUS-FNA procedures.
- Comparison of bleeding complications between patients on clopidogrel and a control group.
Main Results:
- Thirty-seven patients were on clopidogrel at the time of biopsy.
- Patients on clopidogrel were significantly older than the control group.
- No clinically significant bleeding complications occurred in either group.
Conclusions:
- Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and esophageal ultrasound fine needle aspiration (EUS-FNA) can be performed safely in patients taking clopidogrel.
- Continuation of clopidogrel is reasonable for EBUS-TBNA or EUS-FNA when stopping the medication is not feasible and the diagnostic information is crucial.
Background:
Clopidogrel is widely used for the prevention of thrombotic vascular complications. Its primary potential toxicity is bleeding. Management of clopidogrel therapy for patients undergoing invasive procedures is an area of ongoing study. We sought to evaluate the bleeding risk for patients undergoing needle aspiration biopsy by endobronchial ultrasound (EBUS) or esophageal ultrasound (EUS) while taking clopidogrel.
Methods:
Retrospective review of sequential cases of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and esophageal ultrasound fine needle aspiration (EUS-FNA).
Results:
Three hundred ninety-five consecutive procedures were reviewed. Thirty-seven patients were taking clopidogrel at time of biopsy. The patients taking clopidogrel were significantly older than those in the control group. Two patients (1%) in the control group were admitted for observation, but neither was found to have a significant bleed. There were no clinically significant bleeding complications in either of the study groups.
Conclusions:
It is reasonable to proceed with EBUS-TBNA or EUS-FNA when both, (1) clopidogrel cannot be stopped and, (2) an important diagnostic question is at stake.
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