Safety of Ultrasound-Guided Fine Needle Aspiration Biopsy of Neck Lesions in Patients Taking Antithrombotic/Anticoagulant Medications

Abu‐Yousef, Monzer M.; Larson, Joshua H.; Kuehn, David M.; Wu, Andrew S.; Laroia, Archana

doi:10.1097/ruq.0b013e31822b5681

Cited by 48 publications

(41 citation statements)

References 12 publications

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“…However, performing US-FNA in patients taking anticoagulant or antithrombotic remains controversial and lacking in evidence, such as randomized controlled study (2,4,7,9,16,33). A recent study of 593 patients who underwent US-FNA on a total of 788 neck lesions reported no significant differ- ences in hematoma formation between patients who were on antithrombotic medications and those who were not (16). In the present study, no hemorrhagic complication developed in patients taking anticoagulant or antithrombotic during US-FNA.…”

Section: Discussioncontrasting

confidence: 47%

“…Few studies have addressed factors related to hemorrhagic complications after US-FNA of thyroid nodules (4,6,16). The most likely mechanism for thyroid hemorrhage after FNA is thought to be venous bleeding into or around the nodules (30,31).…”

Section: Discussionmentioning

confidence: 99%

“…If the patient is taking an anticoagulant or antithrombotic, stopping the medication for 3 -10 days is recommended before and after US-FNA (4,5,9,11,17,18). However, performing US-FNA in patients taking anticoagulant or antithrombotic remains controversial and lacking in evidence, such as randomized controlled study (2,4,7,9,16,33). A recent study of 593 patients who underwent US-FNA on a total of 788 neck lesions reported no significant differ- ences in hematoma formation between patients who were on antithrombotic medications and those who were not (16).…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, no hemorrhagic complication developed in patients taking anticoagulant or antithrombotic during US-FNA. Thus, we suggest that US-FNA of thyroid nodules can be performed safely in patients who are taking antithrombotic or anticoagulant without stopping the medications without the increased risk of cardiac or thromboembolic events (16). Additionally, the procedure may reduce patient time and expense by eliminating repeated clinic appointments and may also reduce the time interval between diagnosis and treatment (16).…”

Section: Discussionmentioning

confidence: 99%

“…Minor hematomas and local pain are the most common clinical complications after US-FNA of thyroid nodules (4)(5)(6). However, few published studies have addressed the factors contributing to hematoma formation after US-FNA of thyroid nodules (2,(4)(5)(6)16). Additionally, performing US-FNA in patients taking anticoagu-sent was waived because of the retrospective nature of the study.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Screening for Thyroid Cancer

Lin

Bowles

Williams

et al. 2017

JAMA

525

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IMPORTANCEThe incidence of detected thyroid cancer cases has been increasing in the United States since 1975. The majority of thyroid cancers are differentiated cancers with excellent prognosis and long-term survival.OBJECTIVE To systematically review the benefits and harms associated with thyroid cancer screening and treatment of early thyroid cancer in asymptomatic adults to inform the US Preventive Services Task Force.

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Screening for Thyroid Cancer

Force¹,

Bibbins‐Domingo

Grossman

et al. 2017

JAMA

236

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he US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms.It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Summary of Recommendation and EvidenceThe USPSTF recommends against screening for thyroid cancer in asymptomatic adults (D recommendation) (Figure 1). Rationale ImportanceIn 2013, the incidence rate of thyroid cancer in the United States was 15.3 cases per 100 000 persons, which represents a significant increase from 1975, when the incidence rate was 4.9 cases per 100 000 persons. 1 The increase in thyroid cancer incidence was 6.7% IMPORTANCE The incidence of thyroid cancer detection has increased by 4.5% per year over the last 10 years, faster than for any other cancer, but without a corresponding change in the mortality rate. In 2013, the incidence rate of thyroid cancer in the United States was 15.3 cases per 100 000 persons. Most cases of thyroid cancer have a good prognosis; the 5-year survival rate for thyroid cancer overall is 98.1%. OBJECTIVE To update the US Preventive Services Task Force (USPSTF) recommendation on screening for thyroid cancer. EVIDENCE REVIEWThe USPSTF reviewed the evidence on the benefits and harms of screening for thyroid cancer in asymptomatic adults, the diagnostic accuracy of screening (including neck palpation and ultrasound), and the benefits and harms of treatment of screen-detected thyroid cancer.FINDINGS The USPSTF found inadequate direct evidence on the benefits of screening but determined that the magnitude of the overall benefits of screening and treatment can be bounded as no greater than small, given the relative rarity of thyroid cancer, the apparent lack of difference in outcomes between patients who are treated vs monitored (for the most common tumor types), and observational evidence showing no change in mortality over time after introduction of a mass screening program. The USPSTF found inadequate direct evidence on the harms of screening but determined that the overall magnitude of the harms of screening and treatment can be bounded as at least moderate, given adequate evidence of harms of treatment and indirect evidence that overdiagnosis and overtreatment are likely to be substantial with population-based screening. The USPSTF therefore determined that the net benefit of screening for thyroid cancer is negative. CONCLUSIONS AND RECOMMENDATIONThe USPSTF recommends against screening for thyroid cancer in asymptomatic adults. (D recomme...

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Safety of Ultrasound-Guided Fine Needle Aspiration Biopsy of Neck Lesions in Patients Taking Antithrombotic/Anticoagulant Medications

Cited by 48 publications

References 12 publications

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

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

Screening for Thyroid Cancer

Screening for Thyroid Cancer

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