Video-assisted mediastinoscopy is safe in patients taking antiplatelet or anticoagulant therapy
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Updated: Feb 5, 2026
Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Charlotte Cohen1, Daniel Pop1, Olivier Aze1
1Department of Thoracic Surgery, Pasteur Hospital, Nice, France.
Background:
The aim of this study was to report our experience with video-assisted mediastinoscopy (VAM) in patients taking antiplatelet (AP) or anticoagulant therapies focusing on perioperative complications (especially haemorrhagic).
Patients And Methods:
We have done a retrospective study from a prospectively maintained database with diagnostic VAM (01/2008-06/2012). We included 54 patients with AP (41 patients - Group A) and anticoagulant (13 patients - Group B) therapies. The control group was formed by 263 patients (Group C). Data regarding the clinical records of the patients, operative time, per- and post-operative complications, total numbers of biopsies and the results of the pathologic examination were collected. We compared the groups A+B versus C, and then A versus C. Statistical differences were calculated by Chi-square test.
Results:
In Group A, we had two minor complications: cardiac arrhythmia and peroperative minor haemorrhage. The mean operative time was 29 min and the mean post-operative stay was 1.08 days. In Group B, we had one minor complication: Peroperative minor haemorrhage. The mean operative time was 35 min and the mean post-operative stay was 1.07 days. In Group C, the mean operative time was 28 min. One death occurred (mortality rate of 0.38%) because of cardiac arrest at the induction of anaesthesia. One major complication occurred (severe respiratory insufficiency needing re-intubation) and eight minor complications. Morbidity rate was 2.28%. Mean post-operative stay was 1.14 days. No statistical difference was noted between groups.
Conclusion:
VAM can be safely performed in patients receiving AP or anticoagulant treatments. There is no increase in peroperative bleeding or post-operative compressive cervico-mediastinal haematoma.
Insights
Video-assisted mediastinoscopy (VAM) is safe for patients on antiplatelet or anticoagulant therapy, with no increased risk of bleeding or hematoma. This procedure is a viable option for mediastinal diagnosis in these patient groups.
Area of Science:
- Thoracic Surgery
- Minimally Invasive Procedures
- Cardiovascular Medicine
Background:
- Video-assisted mediastinoscopy (VAM) is an established diagnostic tool.
- Patients undergoing VAM often have comorbidities requiring antiplatelet (AP) or anticoagulant (AC) therapy.
- The safety of VAM in patients on these therapies requires evaluation.
Purpose of the Study:
- To assess the safety and perioperative complications of VAM in patients on AP or AC therapy.
- To compare complication rates between patients on AP/AC therapy and a control group.
- To evaluate the risk of hemorrhagic complications during VAM in this population.
Main Methods:
- Retrospective analysis of a prospectively maintained database (01/2008-06/2012).
- Inclusion of 54 patients on AP (n=41) or AC (n=13) therapies (Groups A & B) and 263 controls (Group C).
- Data collected on clinical records, operative time, complications, biopsies, and pathology; statistical analysis using Chi-square test.
Main Results:
- Group A (AP): 2 minor complications (arrhythmia, minor hemorrhage). Mean operative time: 29 min. Mean post-op stay: 1.08 days.
- Group B (AC): 1 minor complication (peroperative hemorrhage). Mean operative time: 35 min. Mean post-op stay: 1.07 days.
- Group C (Control): 1 death (0.38%), 1 major complication, 8 minor complications. Morbidity: 2.28%. Mean post-op stay: 1.14 days. No statistical differences between groups.
Conclusions:
- Video-assisted mediastinoscopy (VAM) can be safely performed in patients on antiplatelet or anticoagulant treatments.
- No increased risk of peroperative bleeding or post-operative compressive cervico-mediastinal hematoma was observed.
- VAM is a safe and effective diagnostic procedure for patients requiring AP or AC therapy.
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