PURPOSE: Thoracentesis is a common procedure for the evaluation of pleural effusions. Many patients requiring thoracentesis are on anti-coagulation such as warfarin or heparin products. There is a growing trend to postpone thoracentesis in these patients until their coagulopathy is reversed or only minimally abnormal. This study was performed to evaluate the risk of bleeding in anticoagulated patients undergoing thoracentesis.
METHODS: Twenty-eight patient had 33 thoracenteses performed while fully anti-coagulated (therapeutic warfarin, unfractionated or low molecular weight heparin or combinations thereof). Each thoracentesis was performed by the author with a standard needle-over-catheter proprietary kit. Immediate and delayed complications were monitored.
RESULTS: Thirty-one of 33 thoracenteses (94%) were performed without apparent bleeding complication. There was no untoward bleeding at the catheter insertion site on any of the patients. One patient had two thoracenteses performed on the same side three days apart. The first aspiration revealed clear yellow transudative fluid while the second aspiration revealed bloody fluid. There were no signs or symptoms of active bleeding in the chest cavity clinically and did not require therapeutic intervention. Another patient had a vaso-vagal reaction following the removal of one liter of bloody fluid in the setting of a leaking thoracic aortic aneurysm. The bloody fluid was deemed secondary to the aneurysmal leak rather than a complication of the procedure.
CONCLUSION: This series of patients demonstrates the safety of thoracentesis in anti-coagulated patients. 94% of the procedures (and arguably more) were uncomplicated by bleeding. Only two patients had unexpected complications that may have been related to bleeding from the procedure. These patients required no therapeutic intervention.
CLINICAL IMPLICATIONS: This study suggests that thoracentesis can be performed safely in anti-coagulated patients. The practice of delaying the procedure until coagulation abnormalities can be reversed or “improved” seems unnecessary and may result in a delay in the evaluation and treatment of pleural effusion in this setting.
DISCLOSURE: George Schoonover, None.