Risk of bleeding in patients undergoing pulmonary procedures on antiplatelet or anticoagulants: A systematic review

Herman, Derrick; Thomson, Carey C.; Brosnhan, S.; Patel, Rakesh; Trosini-Désert, V.; Bilaçeroğlu, Semra; Poston, Jason; Liberman, Moïshe; Shah, Pallav L.; Ost, David; Chatterjee, Ranee; Michaud, Gaëtane

doi:10.1016/j.rmed.2019.05.018

Cited by 10 publications

(10 citation statements)

References 52 publications

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“…The type of bronchoscope and the size of cryoprobe were selected by each operator based on CT images and VB navigation. Though treatment with antiplatelet or anticoagulant agents was discontinued before bronchoscopy, bridging anticoagulation therapy was performed in patients with high thromboembolic risk [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Safety profile and risk factors for bleeding in transbronchial cryobiopsy using a two-scope technique for peripheral pulmonary lesions

et al. 2022

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Background A balloon occlusion technique is suggested for use in cryobiopsy for interstitial lung diseases because of the bleeding risk. However, it may interfere with selection of the involved bronchus for peripheral pulmonary lesions (PPLs). A two-scope technique, in which two scopes are prepared and hemostasis is started using the second scope immediately after cryobiopsy, has also been reported. This study aimed to evaluate the safety and diagnostic utility of transbronchial cryobiopsy using the two-scope technique for PPLs. Methods Data of patients who underwent conventional biopsy followed by cryobiopsy using the two-scope technique for PPLs from November 2019 to March 2021 were collected. The incidence of complications and risk factors for clinically significant bleeding (moderate to life-threatening) were investigated. Diagnostic yields were also compared among conventional biopsy, cryobiopsy, and the combination of them. Results A total of 139 patients were analyzed. Moderate bleeding occurred in 25 (18.0%) patients without severe/life-threatening bleeding. Although five cases required transbronchial instillation of thrombin, all bleeding was completely controlled using the two-scope technique. Other complications included two pneumothoraces and one asthmatic attack. On multivariable analysis, only ground-glass features (P < 0.001, odds ratio: 9.30) were associated with clinically significant bleeding. The diagnostic yields of conventional biopsy and cryobiopsy were 76.3% and 81.3%, respectively (P = 0.28). The total diagnostic yield was 89.9%, significantly higher than conventional biopsy alone (P < 0.001). Conclusions The two-scope technique provides useful hemostasis for safe cryobiopsy for PPLs, with a careful decision needed for ground-glass lesions.

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Section: Methodsmentioning

confidence: 99%

Safety profile and risk factors for bleeding in transbronchial cryobiopsy using a two-scope technique for peripheral pulmonary lesions

et al. 2022

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“…CAT also increased the frequency of haemorrhagic complications requiring intervention after prostate biopsy 15 . In contrast, a study reported no association between the risk of bleeding after percutaneous endoscopic gastrostomy and CAT; pulmonary procedures under CAT did not increase the risk of bleeding either 16 7,11,12 …”

Section: Discussionmentioning

confidence: 98%

“…15 In contrast, a study reported no association between the risk of bleeding after percutaneous endoscopic gastrostomy and CAT; pulmonary procedures under CAT did not increase the risk of bleeding either. 16 Various reports have also concluded that CAT is not a risk factor for bleeding after minimally invasive surgeries, such as tooth extraction, percutaneous endoscopic gastrostomy and endoscopic variceal ligation. 7,11,12 The results of the present study support these findings and suggest that ST can be safely performed even under CAT.…”

Section: Discussionmentioning

confidence: 99%

Safety of surgical tracheostomy under continued antithrombotic therapy: A retrospective cohort study

Sugaya

Ueha

Sato

et al. 2021

Clinical Otolaryngology

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“…15 In contrast, a study reported no association between the risk of bleeding after percutaneous endoscopic gastrostomy and CAT; pulmonary procedures under CAT did not increase the risk of bleeding either. 16 Various reports have also concluded that CAT is not a risk factor for bleeding after minimally invasive surgeries, such as tooth extraction, percutaneous endoscopic gastrostomy, and endoscopic variceal ligation. 7,11,12 The results of the present study support these findings and suggest that ST can be safely performed even under CAT.…”

Section: Discussionmentioning

confidence: 99%

Safety of surgical tracheostomy under continued antithrombotic therapy

Sugaya

Ueha

Sato

et al. 2021

Preprint

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Objective: Although various guidelines have been established for the management of antithrombotic therapy during surgical treatments, surgical tracheostomy (ST) under continued antithrombotic therapy (CAT) remains a challenge. We investigated the risk factors for complications after ST by focusing on CAT use during ST. Method: Patients’ medical records from 2009 to 2020 were reviewed in this retrospective study. We selected patients who underwent ST at the Department of Otolaryngology of the University of Tokyo Hospital. Patient demographics, complications, and blood test values were recorded and statistically analyzed to identify the risk factors for postoperative complications. Results: We identified 288 patients (median age: 64 years; 184 men [64%]), among whom 40 (median age: 67 years; 29 men [73%]) underwent CAT. Although the patients undergoing CAT had significantly higher values of activated partial thromboplastin time (p = 0.002) and prothrombin time-international normalized ratio (p = 0.006) than those of antithrombotic naïve patients, no statistically significant intergroup differences were observed in the risks of bleeding, infection, or subcutaneous emphysema. Instead, ST under local anesthesia (p = 0.01) and ST for airway emergency (p = 0.02) significantly increased the risk of early postoperative complications. Conclusion: The results of the present study suggest that ST under CAT can be safely performed without any increased risk of postoperative complications. Nevertheless, surgeons should be extra cautious about early complications after ST under local anesthesia without intubation or ST for airway emergency. Key points: 1. We aimed to investigate the risk factors for complications after ST by focusing on CAT use during ST. 2. Patients undergoing CAT had significantly higher values of APTT and PT-INR than those of antithrombotic naïve patients. 3. ST under CAT can be safely performed without any increased risk of postoperative complications. 4. ST under local anesthesia and airway emergency was a risk factor for complications after ST. 5. Among the complications, subcutaneous emphysema was significantly more frequent in ST under local anesthesia and under airway emergency.

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Risk of bleeding in patients undergoing pulmonary procedures on antiplatelet or anticoagulants: A systematic review

Cited by 10 publications

References 52 publications

Safety profile and risk factors for bleeding in transbronchial cryobiopsy using a two-scope technique for peripheral pulmonary lesions

Safety profile and risk factors for bleeding in transbronchial cryobiopsy using a two-scope technique for peripheral pulmonary lesions

Safety of surgical tracheostomy under continued antithrombotic therapy: A retrospective cohort study

Safety of surgical tracheostomy under continued antithrombotic therapy

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