Endobronchial biopsies in patients receiving clopidogrel and aspirin treatment

Some patients undergoing pulmonary procedures are on at least one antiplatelet or anticoagulant agent. Discontinuing these treatments can be challenging due to the risk of severe complications, particularly following acute coronary event. While studies indicate that clopidogrel cessation is necessary before transbronchial biopsy, others suggest it may be safely continued for procedures such as endobronchial ultrasound-guided transbronchial needle aspiration. There is limited literature on performing endobronchial biopsies while patients are on clopidogrel (a P2Y12 inhibitor), with only one case report available.

In our three cases, the patients had endobronchial lesions causing partial or complete airway obstruction, leading to severe dyspnea and wheezing. Two of the patients were on dual antiplatelet therapy (DAPT) due to recent coronary artery syndrome treated with coronary stents, while the third was receiving the same treatment for peripheral artery disease managed with a stent. Endobronchial biopsies (EBB) were performed on all three patients without any major complications.

Although it is typically recommended to discontinue clopidogrel 5-7 days prior to the procedure, early diagnosis and treatment are crucial in certain cases. In these situations, where the benefits may outweigh the risks, EBB can be performed with appropriate precautions. Through our case reports, we aim to encourage further prospective studies and the establishment of updated guidelines, particularly concerning EBB in patients receiving DAPT.