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

Abstract

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.

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

“…The latest published review article summarizing the available data on this topic concluded that it might be safe to do urgent thoracocentesis on patients using clopidogrel. However, clopidogrel is better withheld for at least five days before the procedure when possible [6].…”

“…On the other hand, several studies published recently found a significant risk of bleeding from performing these procedures on such patients. Thus, they recommended holding antiplatelet therapy, when possible, five days before such procedures or conducting large randomized controlled trials (RCTs) to assess its safety [6][7]. The Society of Interventional Radiology (SIR) published guidelines in 2012 which stated that for Category 1 procedures, including thoracocentesis, clopidogrel should be held for one to five days prior to 1 2…”

Advances and Controversies in Thoracentesis and Medical Thoracoscopy

“…The authors concluded that there is an acceptable safety profile to perform urgent thoracentesis or chest tube placement in patients taking clopidogrel, but that additional studies are needed. 15…”