[Thoracentesis in the setting of thrombocytopenia : current guidelines]

Thoracentesis, even in patients with significant thrombocytopenia, carries a very low risk of major bleeding when performed under ultrasound guidance. Based on observational studies, current guidelines challenge the need for routine coagulation testing or prophylactic platelet transfusion. Low-quality and mainly indirect evidence suggests the safety of a platelet threshold above 20 × 109/l. Avoiding thoracentesis based solely on laboratory values may delay diagnosis, prompt more invasive procedures, and increase complication risk. Clinical decision-making should be guided by an individualized risk-benefit assessment rather than fixed laboratory thresholds.