Bilateral Hemothorax Secondary to Combined Antiplatelet Therapy With Clopidogrel and Acetylsalicylic Acid

Estarriol, M. Haro; Castillo, Luis Alberto Álvarez; Padró, Xavier Baldó; Rispau, Anna Palou; Garay, M. Rubio; Goday, M. Rubio

doi:10.1016/s1579-2129(06)60148-1

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…Two months post-cardiac catheterization, the patient presented with spontaneous symptomatic bilateral pleural effusions with thoracentesis suggestive of hemorrhagic pleural effusions, which was likely secondary to the use of DAPT in our patient with a history of chronic hemodialysis with platelet dysfunction and changes in the interaction between platelets and walls of the vessel. This association is quite rare and, to our knowledge per our literature review, only a single case has been reported with similar findings [ 18 ].…”

Section: Discussionmentioning

confidence: 77%

A Case of Bilateral Hemorrhagic Pleural Effusion Due to Dual Antiplatelet Therapy in a Dialysis Patient

Jahir¹,

Hossain²,

Dolkar³

et al. 2022

Cureus

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Etiologies of hemorrhagic pleural effusions (hemithoraces) are multifactorial. They can be traumatic, non-traumatic, or idiopathic in nature. In this report, we present a rare case of a 64-year-old male with end-stage renal disease (ESRD) on chronic hemodialysis and dual antiplatelet therapy (DAPT), due to a recent history of coronary arterial stent placement, who presented with progressive shortness of breath for one month. The CT of the chest revealed bilateral large pleural effusions (left > right) with a complete collapse of the left lung and partial collapse of the right lung. Ultrasound-guided left-sided thoracentesis revealed hemorrhagic pleural effusions. After the discontinuation of DAPT, drainage from the right-sided pleural effusion via a pigtail catheter showed continued drainage of pleural fluid without hemorrhage. The effusion on the left side was also noted to have resolved on the repeat chest X-ray. Prompt recognition of this rare cause of any hemorrhagic pleural effusion is essential for patients on dialysis to avoid complications. This report focuses on the possible etiology and potential complications of a hemorrhagic pleural effusion, followed by a brief discussion on the rare but significant association involving the incidence of a hemorrhagic pleural effusion in a dialysis patient receiving DAPT.

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Section: Discussionmentioning

confidence: 77%

A Case of Bilateral Hemorrhagic Pleural Effusion Due to Dual Antiplatelet Therapy in a Dialysis Patient

Jahir¹,

Hossain²,

Dolkar³

et al. 2022

Cureus

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“…Similarly, another case published in the Spanish literature in 2006 reported spontaneous, massive bilateral hemothoraces in a patient who took dual anti-platelet therapy of aspirin and clopidogrel after a coronary DES placement [13]. This also triggers further pharmacological assessment of clopidogrel sensitivity in different patients, as it is a prodrug that needs enzymatic activation in the liver by CYP2C19 [13]. Some patients lack this enzyme.…”

Section: Discussionmentioning

confidence: 95%

“…A case published in the Spanish literature in 2009 reported a patient with pulmonary and pleural hemorrhage after massive clopidogrel intake as a suicidal attempt [12], which makes one wonder why bleeding occurred specifically in these body organs. Similarly, another case published in the Spanish literature in 2006 reported spontaneous, massive bilateral hemothoraces in a patient who took dual anti-platelet therapy of aspirin and clopidogrel after a coronary DES placement [13]. This also triggers further pharmacological assessment of clopidogrel sensitivity in different patients, as it is a prodrug that needs enzymatic activation in the liver by CYP2C19 [13].…”

Section: Discussionmentioning

confidence: 96%

Acute Hemothorax Causing Hemorrhagic Shock Following Small-bore Thoracocentesis in a Patient on Clopidogrel: A Case Report and Literature Review

Asmar¹,

Zeid²

2020

Cureus

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Clopidogrel is one of the most commonly prescribed thienopyridines used postcoronary stenting for acute coronary syndrome (ACS). There have been several concerns regarding performing small-bore thoracocentesis on patients on clopidogrel in our practice. We present an 85-year-old male with a history of diabetes, atrial fibrillation, diastolic heart failure, chronic kidney disease (CKD) stage three, who recently had a non-ST elevation myocardial infarction (NSTEMI) requiring a drug-eluting stent (DES) to the left anterior descending (LAD) artery, and was on dual anti-platelet therapy (DAPT). He was admitted with worsening shortness of breath and found to have bilateral pleural effusions. He required several small-bore, ultrasoundguided thoracocentesis on the right side while on clopidogrel. Intensivists or residents did all the procedures. The patient went into a hemorrhagic shock following his third small-bore thoracocentesis, requiring pressors, blood and platelet transfusions, and a surgical intercostal (IC) drain insertion. He eventually became clinically stable. An IC arteriogram within 24 h ruled out IC artery injury. Healthcare professionals perceive small-bore thoracocentesis as a safe procedure done on medical, surgical, intensive care, and interventional radiology (IR) units. The overall consensus is that it is safe to perform it on patients taking clopidogrel. We emphasize through this case report the bleeding risks associated with performing such procedures on patients while on clopidogrel and considering holding clopidogrel when feasible or bridging with an intravenous anti-platelet drug.

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“…As the cause of hemothorax, clopidogrel has been reported in 3 cases [10][11][12]. Haro Estarriol et al reported one hemothorax case after coronary angioplasty and stenting with clopidogrel therapy to treat unstable angina [11].…”

Section: Discussionmentioning

confidence: 99%

Hemothorax after chest tube insertion for pneumothorax as a complication of clopidogrel

et al. 2013

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AbstractHemorrhagic complications are recognized when anti-platelet agents are used during or after surgical procedures. We present a 69-year-old male patient who developed hemothorax after chest tube insertion for pneumothorax as a complication of clopidogrel and aspirin following ischemic heart disease. Hemothorax associated clopidogrel has rarely been reported and this is the first academic publication of this complication type following chest tube insertion shortly after the cessation of clopidogrel. Our case demonstrates the possibility of hemothorax when chest tube insertion is indicated under such conditions.

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Bilateral Hemothorax Secondary to Combined Antiplatelet Therapy With Clopidogrel and Acetylsalicylic Acid

Cited by 7 publications

References 18 publications

A Case of Bilateral Hemorrhagic Pleural Effusion Due to Dual Antiplatelet Therapy in a Dialysis Patient

A Case of Bilateral Hemorrhagic Pleural Effusion Due to Dual Antiplatelet Therapy in a Dialysis Patient

Acute Hemothorax Causing Hemorrhagic Shock Following Small-bore Thoracocentesis in a Patient on Clopidogrel: A Case Report and Literature Review

Hemothorax after chest tube insertion for pneumothorax as a complication of clopidogrel

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