Procedures: Procedures 2 |

Should Antiplatelets Be Withheld for Transthoracic Needle Aspiration? FREE TO VIEW

Sandra Hui; Jansen Meng Kwang Koh; Carmen Jia Wen Kam; Angeline Poh
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Singhealth, Singapore, Singapore

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

Chest. 2016;150(4_S):1018A. doi:10.1016/j.chest.2016.08.1124
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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: Transthoracic needle aspiration (TTNA) is a common procedure done for indeterminate pulmonary lesions. Pulmonary haemorrhage is the second most common complication associated with TTNA. Antiplatelets have proven life-saving benefits in patients with ischemic heart disease and cerebrovascular conditions. However they are associated with an increased risk of bleeding. Patients on these medications are prevalent, yet there is no clear guideline as to the cessation or continuation of antiplatelet therapy for TTNA as the risk benefit ratio has not been clearly defined. The aims of this study is to determine if the use of antiplatelets during TTNA increases the risk of bleeding and if withholding these medications would result in ischemic complications such as acute myocardial infarct or cerebrovascular events.

METHODS: This was a retrospective study which included all patients undergoing TTNA at Changi General Hospital, Singapore, from 1st January 2012 to 23rd February 2015. Demographic data, antiplatelet use, bleeding complications and ischemic events were collected and analysed.

RESULTS: A total of 190 patients [average age 67.0±12.7 years old; 136 (71.6%) male; 134 (70.5%) Chinese, 48 (25.3%) Malay, 6 (3.2%) Indian and 2 (1.1%) other races] were analysed. Forty-six (24.2%) patients were on antiplatelets as compared to 144 (75.8%) patients who were not. Of these 46 patients, 39 (84.8%) patients had their antiplatelets stopped prior. Patients who were on antiplatelets prior to TTNA were older, more males and had more cardiovascular conditions as expected. Bleeding parameters including platelet level and coagulation profile were similar between the 2 groups. Based on the adjusted Logistics Regression model, chronic kidney disease is the only risk factor identified to have an increased risk of bleeding complications (adjusted OR 21.6, CI 1.5-320.7, p=0.03). 15.2% (7/46) of patients on antiplatelet therapy had bleeding complications, such as minor pulmonary haemorrhage, minor hemoptysis and hemothorax, compared to 10.4% (15/144) of patients without antiplatelet therapy, which was not statistically significant [OR 1.5, 95% CI (0.6 - 4.1), p=0.38). None of the patients whom antiplatelets were stopped had any complications from cessation of antiplatelets such as acute myocardial infarct or cerebrovascular events.

CONCLUSIONS: Our study showed that there is no increased risk of bleeding complications during transthoracic needle aspiration for patients on antiplatelets. Cessation of antiplatelets prior to TTNA is also not associated with an increased risk of ischemic complications.

CLINICAL IMPLICATIONS: The results from this study can inform us on the bleeding risk of antiplatelet use in TTNA and the risk of complications associated with cessation of antiplatelets for the procedure. This is important for clinicians to decide on the current workflow of stopping antiplatelets for patients undergoing TTNA as there is no clear guidelines established.

DISCLOSURE: The following authors have nothing to disclose: Sandra Hui, Jansen Meng Kwang Koh, Carmen Jia Wen Kam, Angeline Poh

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