Management of anticoagulant and antiplatelet therapy in patients undergoing interventional pulmonary procedures

Pathak, Vikas; Allender, J. Erin; Grant, Mollie

doi:10.1183/16000617.0020-2017

Cited by 32 publications

(35 citation statements)

References 37 publications

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“…The only absolute contraindication for tube thoracostomy is the lack of informed consent or patient cooperation. Relative contraindications include uncorrected coagulopathy (e.g., patients with international normalized ratio >1.5–2 or with a platelet count <50,000/µL) and instrumental access to the pleural cavity without image-guidance in patients with substantial pleuro-pulmonary adhesions or multiloculations 3 4 . Chest tube insertion over an infected skin area should be avoided.…”

Section: Indications and Contraindications Of Chest Tube Placementmentioning

confidence: 99%

Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists

Porcel

2018

Tuberc Respir Dis

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Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity (“water seal”) drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.

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Section: Indications and Contraindications Of Chest Tube Placementmentioning

confidence: 99%

Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists

Porcel

2018

Tuberc Respir Dis

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“…While interruption of anticoagulation is generally preferred prior to PT, patients who require continued active anticoagulation can still undergo PT, and most bleeding complications can be managed with compression, transfusion, and cautery. 55…”

Section: Percutaneous Tracheostomy On Antiplatelet Agents and Anticoamentioning

confidence: 99%

Percutaneous Tracheostomy

Al-Shathri

Susanto

2018

Semin Respir Crit Care Med

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Tracheostomy is a commonly performed surgical procedure in intensive care units (ICUs). Over the past three decades, there has been a substantial body of evidence to suggest percutaneous tracheostomy (PT) is at least as safe as surgical tracheostomy (ST) in the hands of trained clinicians. In most institutions, PT is more readily performed at bedside than ST in the ICU; hence, PT is an attractive alternative to ST in the ICU. Bedside PT generates significant cost savings by eliminating operating room and anesthesia charges. Bronchoscopy is commonly used as a visual aid during PT. Ultrasound (US)-guided PT is gaining popularity. It can be used as an adjunct or alternative to bronchoscopic-guided PT, especially in hospitals where access to bronchoscopy remains fairly limited and US is more widely available. There are many benefits in converting translaryngeal intubation to tracheostomy. It is widely accepted that tracheostomy is preferred if there is an anticipation of prolonged need for an artificial airway. The timing of this conversion from translaryngeal intubation to tracheostomy remains a subject of controversy. Limited data are available regarding the safety of PT on patients who are on dual antiplatelet therapy or active anticoagulation. Given the heterogeneity of PT techniques, adequate training and experience with the technique, coupled with careful planning are essential in minimizing any potential complication.

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“…We read with interest the recent papers by ABUQAYYAS et al [1] and PATHAK et al [2] as well as the associated editorial by HERTH [3], which all highlighted the safety issues of bronchoscopy with antithrombotic agents. However, there is also a significant issue with regard to a bronchoscopist's ability to manage bleeding and their level of training.…”

Section: To the Editormentioning

confidence: 99%

“…The present authors' practice is to check coagulation routinely prior to this mode of biopsy. The articles published by ABUQAYYAS et al [1] and PATHAK et al [2] provide an excellent review of the current evidence base in the management of antithrombotic agents prior to bronchoscopy, and will help guide daily practice.…”

Section: To the Editormentioning

confidence: 99%