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Original Research: Pulmonary Procedures |

Safety of Ultrasound-Guided Thoracentesis in Patients With Abnormal Preprocedural Coagulation ParametersThoracentesis in Patients With Coagulopathy

Rebecca M. Hibbert, MD; Thomas D. Atwell, MD; Alexander Lekah, MD; Maitray D. Patel, MD; Rickey E. Carter, PhD; Jennifer S. McDonald, PhD; Jeffrey T. Rabatin, MD, FCCP
Author and Funding Information

From the Department of Medical Imaging (Dr Hibbert), University of Ottawa, Ottawa, ON, Canada; the Department of Radiology (Drs Hibbert, Atwell, Lekah, and McDonald), the Department of Health Sciences Research (Dr Carter), and the Department of Pulmonary and Critical Care Medicine (Dr Rabatin), Mayo Clinic School of Medicine, Rochester, MN; and the Department of Radiology (Dr Patel), Mayo Clinic, Phoenix, AZ.

Correspondence to: Thomas D. Atwell, MD, Department of Radiology, Mayo Clinic School of Medicine, 200 First St SW, Rochester, MN 55905; e-mail: atwell.thomas@mayo.edu


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):456-463. doi:10.1378/chest.12-2374
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Background:  Despite a low incidence of hemorrhagic complications following thoracentesis, correction or attempted correction of abnormal preprocedural coagulation parameters is still commonly performed. We aimed to assess hemorrhagic complications following ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters.

Methods:  We analyzed 1,009 ultrasound-guided thoracenteses performed between January 2005 and September 2011 on patients with international normalized ratio (INR) > 1.6, serum platelet values < 50 × 109/L, or both. Procedures were divided into two groups: those in whom abnormal preprocedural coagulation parameters were not corrected before the thoracentesis (group 1) and a second group in which patients received a transfusion of platelets or fresh frozen plasma prior to thoracentesis (group 2). All procedures were evaluated for hemorrhagic complications as defined by the National Institutes of Health Common Terminology Criteria for Adverse Events.

Results:  A total of 1,009 ultrasound-guided thoracenteses were included in our study, consisting of 706 procedures in 538 patients in group 1 and 303 procedures in 235 patients in group 2. There were four hemorrhagic complications out of 1,009 procedures (0.40%; 95% CI, 0.15%-1.02%): zero in group 1 (0 of 706 or 0.0%; 95% CI, 0%-0.68%) and four in group 2 (four of 303 or 1.32%; 95% CI, 0.51%-3.36%).

Conclusions:  Hemorrhagic complications are infrequent after ultrasound-guided thoracentesis, and attempting to correct an abnormal INR or platelet level before the procedure is unlikely to confer any benefit. We consider the procedure safe in patients with abnormal preprocedural parameters when performed by expert personnel.


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