Chest
Volume 144, Issue 2, August 2013, Pages 456-463
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Original Research
Pulmonary Procedures
Safety of Ultrasound-Guided Thoracentesis in Patients With Abnormal Preprocedural Coagulation Parameters

https://doi.org/10.1378/chest.12-2374Get rights and content

Background

Despite a low incidence of hemorrhagic complications following thoracentesis, correction or attempted correction of abnormal preprocedural coagulation parameters is still commonly performed. We aimed to assess hemorrhagic complications following ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters.

Methods

We analyzed 1,009 ultrasound-guided thoracenteses performed between January 2005 and September 2011 on patients with international normalized ratio (INR) > 1.6, serum platelet values < 50 × 109/L, or both. Procedures were divided into two groups: those in whom abnormal preprocedural coagulation parameters were not corrected before the thoracentesis (group 1) and a second group in which patients received a transfusion of platelets or fresh frozen plasma prior to thoracentesis (group 2). All procedures were evaluated for hemorrhagic complications as defined by the National Institutes of Health Common Terminology Criteria for Adverse Events.

Results

A total of 1,009 ultrasound-guided thoracenteses were included in our study, consisting of 706 procedures in 538 patients in group 1 and 303 procedures in 235 patients in group 2. There were four hemorrhagic complications out of 1,009 procedures (0.40%; 95% CI, 0.15%-1.02%): zero in group 1 (0 of 706 or 0.0%; 95% CI, 0%-0.68%) and four in group 2 (four of 303 or 1.32%; 95% CI, 0.51%-3.36%).

Conclusions

Hemorrhagic complications are infrequent after ultrasound-guided thoracentesis, and attempting to correct an abnormal INR or platelet level before the procedure is unlikely to confer any benefit. We consider the procedure safe in patients with abnormal preprocedural parameters when performed by expert personnel.

Section snippets

Materials and Methods

Approval for this retrospective study was obtained from our institutional review board (Mayo Clinic Institutional Review Board #11-006350). The study was compliant with the Health Insurance Portability and Accountability Act.

Results

A total of 1,059 ultrasound-guided thoracenteses were initially identified as being eligible for review. Fifty procedures (5%) were excluded, as patients had not authorized their records for use in research. The resulting sample consisted of 773 patients having undergone 1,009 procedures. Table 1 presents the demographic, preprocedural laboratory results and procedural summary for the 773 patients at their first procedure. A majority of the sample was men (53%), and the mean age was 67 (±15)

Discussion

The precise incidence of hemorrhagic complications following ultrasound-guided thoracentesis by expert operators in patients with abnormal preprocedural coagulation parameters remains unclear. Moreover, the benefit of preprocedural transfusion of platelets or FFP prior to these procedures remains controversial. We present, to our knowledge, the largest series of ultrasound-guided thoracenteses specifically evaluating a population with abnormal preprocedural coagulation parameters. We show that

Conclusions

Hemorrhagic complications are infrequent after ultrasound-guided thoracentesis, and preprocedure transfusion to correct an abnormal INR or platelet level before the procedure is unlikely to confer any benefit. We consider the procedure to have low risk of hemorrhagic complications in patients with abnormal preprocedural coagulation parameters when performed by experienced personnel under direct ultrasound guidance.

Acknowledgments

Author contributions: Dr Hibbert is the guarantor of this article.

Dr Hibbert: contributed to study conception and design; acquisition, analysis, and interpretation of data; drafting of the manuscript; and revising, reading, and approving the final version of the manuscript.

Dr Atwell: contributed to study conception and design; oversight and conduct of the study; analysis and interpretation of data; and revising, reading, and approving the final version of the manuscript.

Dr Lekah: contributed to

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    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

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