Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications

Abstract

Background: Thyroid nodules are a common clinical problem and ultrasound-guided fine needle aspiration (US-FNA) biopsy is widely used for evaluation of thyroid nodules. However, few studies have addressed the contributing factors to hemorrhage after US-FNA of thyroid nodules. Objectives: To assess the contributory factors related to patient characteristics, ultrasound (US) features of the thyroid nodules, and the US-FNA procedures to affect hemorrhage complications after US-FNA of thyroid nodules. Methods: Between March 2014 and April 2015, 366 consecutive patients who underwent US-FNA of thyroid nodules were enrolled in this retrospective study. The characteristics of hematomas, including the location, maximum size, and clinical course, were assessed. The relationships between hematomas and factors related to the medical characteristics of patients, US characteristics of the nodules, and FNA procedural factors were analyzed. Results: Data on 365 nodules in 321 patients who underwent US-FNA of thyroid nodules were analyzed. Minor hemorrhagic complications developed in 14 (3.8%) of the 365 nodules. There were no statistically significant differences between patients taking or not taking an anticoagulant or antithrombotic (P = 0.270). Factors related to increased risk of hematoma were male sex (P = 0.031), larger maximum size (P = 0.002), a cystic or predominantly cystic nodule (P < 0.0001), a probable benign nodule (P < 0.0001), thicker needle size (P < 0.0001), and a greater number of the needle passes (P = 0.005). Conclusions: US-FNA can be performed safely even in patients taking anticoagulant or antithrombotic agents. Factors related to hemorrhagic complications are male sex, larger nodules, cystic or predominantly cystic nodules, probably benign nodules, thicker needles and a greater number of needle passes.

A Case of Diffuse Thyroid Hematoma after Ultrasound-Guided Fine Needle Aspiration

“…Ultrasound-guided FNA of thyroid nodules is a simple, minimally invasive, and safe test generally performed in ambulatory care [1,8]. The most common complications are local pain or discomfort and mild hematoma [9].…”

Extracapsular Cervical Hematoma After Thyroid Fine-Needle Aspiration Cytology

“…The patient was kept under close surveillance and the hematoma was monitored by imaging tests (CT). However, given the unfavorable evolution with its persistence and compressive effect on the trachea, surgical drainage was necessary [ 4 , 6 ].…”

“…The presence of factors such as hemorrhagic disorders, anticoagulant/anti-platelet drugs, and hypertension increases the susceptibility to hemorrhagic complications [ 4 , 6 ]. The risk is also increased in the presence of a hypervascularized gland, nodules composed of numerous aberrant vessels with relatively thin walls, and intra-nodular arteriovenous derivations [ 2 , 7 ].…”

Tiroid Nodül İnce İğne Biyopsinde Yeterli Tanısal Numune Almaya İğne Boyutunun Etkisi

“…Anticoagulant antithrombotic drugs should be discontinued 3-10 days before FNAB, due to the increased risk of hemorrhagic complications. [18] It has been reported that on-site evaluation of the FNAB specimens by a cytopathologist decrease the biopsy repetition rates and false-negative results and increase the biopsy success. [4,19] Stacul et al found that on-site cytopathological evaluation reduced the diagnostic failure rates from 14% to 4%.…”