Thoracentesis and the risks for bleeding

Abstract

Although large randomized studies do not exist, recent literature suggests that it is time to reevaluate the need to correct INR and platelet counts or to transfuse blood products or withhold medications prior to thoracentesis in patients felt to have a risk of possible bleeding.

Advances and Controversies in Thoracentesis and Medical Thoracoscopy

“…These have been recently summarized. 3,12,13 Since those publications, another retrospective study in patients with advanced malignancy who underwent thoracentesis was performed. Forty-one of 436 patients had severe thrombocytopenia, defined as a platelet count < 30 Â 10 9 U/L.…”

Safe and Effective Bedside Thoracentesis: A Review of the Evidence for Practicing Clinicians

“…For instance, a prospective study of approximately 9000 thoracenteses over 12 years found that patients with an INR of 1.5-2.9 or platelets of 20,000 -49,000/µL experienced rates of bleeding complications similar to those with normal values. 20 Similarly, a 2014 review 21 found that the overall risk of hemorrhage during thoracentesis in the setting of moderate coagulopathy (defined as an INR of 1.5 -3 or platelets of 25,000-50,000/µL), was not increased. In 1 retrospective study of more than 1000 procedures, no differences in hemorrhagic events were noted in patients with bleeding diatheses that received prophylactic fresh frozen plasma or platelets vs. those who did not.…”

Complications of thoracentesis

“…The incidence of hemothorax following thoracentesis remains low despite operators increasingly performing procedures on patients with known bleeding risk factors [10]. Ault et al identified only 17 (0.18%) bleeding complications post-thoracentesis procedures, only five of which were hemothoraces (0.01%).…”

“…Specifically, this has led to barriers in the study of the true incidence of therapeutic complications, that is complications not present prior to a procedural intervention, in surgical laparoscopy, and in left ventricular assist device placement [7][8][9]. Nevertheless, in the last several years more evidence has emerged allowing prediction and prevention of thoracentesis complications [6,10].…”