Study objective: To determine whether recipients of
lung transplants have a higher risk of bleeding from fiberoptic
bronchoscopy (FOB) than other patients who undergo the procedure.
Design: Prospective cohort study.
Bronchoscopy services of Johns Hopkins Hospital, a tertiary referral
center and Johns Hopkins Bayview Medical Center, a community
Patients: All adult patients (18 years) who
underwent FOB between July 1, 1996 and June 30, 1997 by the full-time
pulmonary medicine staff were included. A total of 720 procedures were
performed, including 38 in lung transplant recipients.
Measurements: Bleeding was assessed by reviewing physician
reports of bloody drainage after the procedure and whether the
procedure was terminated early for bleeding. Patient reports of
hemoptysis were assessed using questionnaires administered pre- and
post-FOB. Predictor variables included patient demographics, bleeding
parameters (platelets, prothrombin time, and activated partial
thromboplastin time), immunosuppressive medications, aspirin use, use
of transbronchial biopsy, and the time length of the procedure.
Results: Lung transplant recipients were
significantly more likely to have used aspirin prior to FOB (18.4 vs
7.2%, p < 0.05) and to undergo transbronchial biopsy (64.9 vs
26.8%, p < 0.001). Lung transplant patients were more likely to
have new or worsened hemoptysis (53.8 vs 24.6%, p < 0.001), to have>
25 mL of blood loss (44.5 vs 17.5%, p < 0.001) and to have the
procedure terminated early for bleeding (5.4 vs 1.0%, p < 0.05). In
multivariate analysis, predictors of new or worsened hemoptysis
included lung transplant, longer procedure time, and older patient age.
Independent predictors of greater blood loss included lung transplant,
performance of transbronchial biopsy, longer procedure time, and older
Conclusions: Lung transplant recipients
are at higher risk of bleeding from bronchoscopy than are other
patients. This propensity to bleed is independent of coagulation
parameters, platelet count, immunosuppressive medication use, aspirin
use, or performance of transbronchial biopsy. The higher risk of
bleeding should be considered when assessing the risks and benefits of
bronchoscopy in lung transplant recipients.
Abbreviations: aPTT = activated partial
thromboplastin time; BRONCHQI = bronchoscopy quality improvement
project; FOB = fiberoptic bronchoscopy; PT = prothrombin time;
TBBx = transbronchial biopsy