Is chest tube insertion with ultrasound guidance safe in patients using clopidogrel?

Abouzgheib, Wissam; Shweihat, Yousef; Meena, Nikhil; Bartter, Thaddeus

doi:10.1111/j.1440-1843.2012.02230.x

Cited by 22 publications

(9 citation statements)

References 13 publications

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“…The retrospective data on pleural drainage and clopidogrel encompass a total of 54 patients across two studies who underwent 67 US-guided small-bore chest tube insertions (53,54). No life-threatening bleeding was reported in any of these procedures.…”

Section: Percutaneous Pleural Procedures and Clopidogrelmentioning

confidence: 99%

Percutaneous pleural drainage in patients taking clopidogrel: real danger or phantom fear?

Linder

Epelbaum

2018

J. Thorac. Dis.

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Despite being categorized as a procedure associated with a low risk of iatrogenic hemorrhage, percutaneous pleural drainage in patients taking the ubiquitous antiplatelet agent clopidogrel is still commonly perceived as a risky proposition. There is mounting evidence, however, in support of the safety of percutaneous needle procedures in persons receiving this medication. Establishing that these pleural interventions can be performed safely without clopidogrel interruption would be of great clinical significance, especially in those taking it for recent cardiac stenting and therefore in danger of stent thrombosis should antiplatelet therapy (APT) be withheld. The purpose of the present review is to summarize the available data from published studies and series of thoracentesis and chest tube insertion in patients exposed to clopidogrel. Also incorporated into this review are relevant investigations from the thoracic surgery and interventional radiology experience, which contribute indirect evidence and help shape the context for interpreting the safety data reported in the pleural literature. At the end, an attempt is made to synthesize the current knowledge on this topic into conclusions for guiding practice.

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Section: Percutaneous Pleural Procedures and Clopidogrelmentioning

confidence: 99%

Percutaneous pleural drainage in patients taking clopidogrel: real danger or phantom fear?

Linder

Epelbaum

2018

J. Thorac. Dis.

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“…Cette opinion concorde avec les données de la littérature qui rapportent une incidence des complications hémorra-giques après drainage thoracique chez des patients sans AAP entre 0 et 4,2 % [11][12][13][14][15][16][17][18][19][33][34][35][36][37]. Une étude prospective monocentrique a rapporté l'absence de complication hémorragique au cours de 24 drainages thoraciques réalisés sous clopidogrel [38]. Dans notre étude, les pneumologues exprimaient peu de réticence à effectuer un drainage thoracique sous aspirine contrairement au clopidogrel.…”

Section: Drainage Thoraciqueunclassified

Gestes pleuraux sous antiagrégants plaquettaires : une enquête d’opinion

Dangers

Similowski

Chenivesse

2016

Revue des Maladies Respiratoires

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“…It has been a controversial topic of whether clopidogrel is associated with significant bleeding risk in patients undergoing simple noninvasive procedures. Literature over the past 15 years was supportive of performing small-bore (<14 Fr), ultrasound-guided thoracocentesis while patients are on clopidogrel [1][2][3][4][5]. On the other hand, several studies published recently found a significant risk of bleeding from performing these procedures on such patients.…”

Section: Introductionmentioning

confidence: 99%

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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Is chest tube insertion with ultrasound guidance safe in patients using clopidogrel?

Abstract: Given the known effects of clopidogrel on platelet function, these results were interpreted as indicating that clopidogrel therapy is a relative but not an absolute contraindication to chest tube insertion, if an experienced operator places a small-bore tube under ultrasound guidance.

Cited by 22 publications

References 13 publications

Percutaneous pleural drainage in patients taking clopidogrel: real danger or phantom fear?

Percutaneous pleural drainage in patients taking clopidogrel: real danger or phantom fear?

Gestes pleuraux sous antiagrégants plaquettaires : une enquête d’opinion

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

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