Procedures: Procedures 2 |

Antiplatelet Therapy in Patients Undergoing EBUS-TBNA: Risk vs Benefit FREE TO VIEW

Kevin Swiatek, DO; Rachel Guthrie, DO; John Elliott, PhD; Kim Jordan, MD
Author and Funding Information

OhioHealth Riverside Methodist Hospital, Columbus, OH

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

Chest. 2016;150(4_S):1017A. doi:10.1016/j.chest.2016.08.1123
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SESSION TITLE: Procedures 2

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has improved the ease with which practitioners can obtain mediastinum tissue samples. However, evidence-based studies are limited regarding best management of dual antiplatelet agents (DAPT) aspirin and clopidogrel, or clopidogrel alone in patients who undergo this procedure. One 2006 study recommended discontinuation of clopidogrel prior to transbronchial biopsy after documenting increased bleeding severity in patients taking clopidogrel. However, a recent retrospective review of 12 patients, suggested that EBUS-TBNA can be performed safely by experienced operators in patients taking clopidogrel. Our study further evaluates adverse bleeding events following EBUS-TBNA in patients exposed to DAPT, clopidogrel only, or aspirin (ASA) alone 5 days prior to the procedure versus patients unexposed to anti-platelet medications.

METHODS: Retrospective chart review was conducted on patients aged 18 or older who underwent EBUS-TBNA between January 1, 2009 and December 31, 2014 at our institution. Patients were excluded from analysis if taking anti-platelet medications other than clopidogrel and/or aspirin, if using therapeutic anticoagulation, if had history of bleeding or clotting disorder, active disseminated intravascular coagulation, or platelet count <80,000. Adverse bleeding events were defined as any one of the following: immediate bleeding requiring procedural interruption and/or topical intervention, red blood cell transfusion requirement within 24 hours of procedure, hemoglobin drop ≥ 2 grams, or readmission within 48 hours of procedure for hemoptysis or anemia. Data included demographics, comorbidities, and pre/post procedure CBC. Data was analyzed via one-way ANOVA and chi-square tests.

RESULTS: Of 476 patients, 67 were excluded. Of the remaining patients: DAPT n=23; clopidogrel n=13; ASA n=103; unexposed n=270. Overall bleeding events were low, occurring in 2.9% of all patients: DAPT n=2 (8.7%); clopidogrel n=1 (7.7%); ASA n=1 (<1%); unexposed n=8 (2.9%), p = 0.164. No immediate bleeding events were recorded for patients taking DAPT or clopidogrel alone, but these patients were more likely to experience hemoglobin drop > 2g: DAPT n=1 (4.3%); clopidogrel n=1 (7.7%); ASA n=0 (0.0%); unexposed n=2 (0.7%), p = 0.019. Patients taking DAPT were more likely to be readmitted in 48 hours: DAPT n=1 (4.3%); clopidogrel n=0 (0.0%); ASA n=0 (0.0%); unexposed n=1 (0.4%), p = 0.053.

CONCLUSIONS: Similar rates of bleeding suggest that discontinuation of DAPT or clopidogrel may not be necessary prior to EBUS-TBNA. However, the absolute number of bleeding complications was low in both exposed and unexposed patients and definitive recommendations require a larger patient population to achieve adequate statistical power.

CLINICAL IMPLICATIONS: Clinicians should weigh individual risks and benefits when deciding to discontinue DPTA or clopidogrel before EBUS-TBNA.

DISCLOSURE: The following authors have nothing to disclose: Kevin Swiatek, Rachel Guthrie, John Elliott, Kim Jordan

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