Procedures: Interventional Pulmonary Procedural Safety and Outcomes |

Thoracentesis in Cirrhotics (TiC Study): Incidence of Hemorrhagic Complications of Thoracentesis in Cirrhotic Patients FREE TO VIEW

Rahim Wooley, MD; Steven Kim, MD; Keith Guevarra
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Rutgers-NJMS, Montclair, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1000A. doi:10.1016/j.chest.2016.08.1106
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SESSION TITLE: Interventional Pulmonary Procedural Safety and Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 26, 2016 at 02:45 PM - 04:15 PM

PURPOSE: Thoracentesis is a procedure commonly performed to diagnose the etiology of and alleviate symptoms of pleural effusions. Studies have shown the safety of thoracentesis in patients with coagulopathies, but none have specifically addressed the risk of hemorrhagic complications in the cirrhotic population. Additionally, blood product transfusion has been associated with its own complications and health care cost. This study retrospectively evaluates the incidence of hemorrhagic complications of thoracentesis in cirrhotic patients over a 12-month period.

METHODS: The medical records of all cirrhotic patients who underwent thoracentesis at the University Hospital (Newark, NJ) over a 12-month period were reviewed, and 66 thoracenteses were recorded. Datapoints extracted from the medical records included peri-procedural vital signs, hemoglobin, platelet count, coagulation studies, whether the patient was taking antiplatelets or anticoagulants, or any blood product transfusions administered periprocedurally. MELD scores were calculated for all patients. Acute and delayed complications were monitored post-procedure. Analyses of two groups was conducted: those who had correction of coagulopathy with transfused blood products, and those who did not have coagulopathy corrected, prior to the thoracentesis. The primary endpoint was the development of a hemorrhagic complication attributable to thoracentesis that required transfusion of blood products or surgical procedures for hemostasis.

RESULTS: All 66 thoracenteses were performed without significant bleeding complications, regardless of the severity of coagulopathy or if blood products were given to correct the coagulopathy. The average INR in patients in our study was 1.6. Average MELD score prior to procedure was 47.7.

CONCLUSIONS: Our study demonstrates a low incidence of hemorrhagic complications of thoracentesis in both study groups: those patients that received blood products for coagulopathy reversal, as well as those patients who did not receive blood products. Reversal of cirrhosis-induced coagulopathy may add delay to thoracentesis, and blood transfusions themselves have associated risk and health care cost.

CLINICAL IMPLICATIONS: Our data indicates that thoracentesis in cirrhotics is safe, even in the presence of uncorrected coagulopathy. Further studies should be performed to determine if long-term outcomes are better in cirrhotic patients undergoing thorcentesis without the administration of blood products to correct coagulopathy.

DISCLOSURE: The following authors have nothing to disclose: Rahim Wooley, Steven Kim, Keith Guevarra

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