Key result
Endobronchial biopsy was performed safely without major bleeding complications (only grade 1 bleeding) in three patients receiving dual antiplatelet therapy with clopidogrel and aspirin.
Why the study?
Discontinuing antiplatelet therapy poses risks after acute coronary events, yet literature on performing endobronchial biopsies while continuing clopidogrel is limited.
Can endobronchial biopsy be safely performed without major bleeding complications in patients continuing dual antiplatelet therapy?
Case Report (n=3)
No
Can endobronchial biopsy be safely performed without major bleeding complications in patients continuing dual antiplatelet therapy?
Endobronchial biopsy may be safely performed with appropriate precautions in patients on dual antiplatelet therapy when urgent diagnosis is required and discontinuing therapy poses high thrombotic risk.
BACKGROUND: Some patients undergoing pulmonary procedures are on at least one antiplatelet or anticoagulant agent. Discontinuing these treatments can be challenging due to the risk of severe complications, particularly following acute coronary event. While studies indicate that clopidogrel cessation is necessary before transbronchial biopsy, others suggest it may be safely continued for procedures such as endobronchial ultrasound-guided transbronchial needle aspiration. There is limited literature on performing endobronchial biopsies while patients are on clopidogrel (a P2Y12 inhibitor), with only one case report available. CASE PRESENTATION: In our three cases, the patients had endobronchial lesions causing partial or complete airway obstruction, leading to severe dyspnea and wheezing. Two of the patients were on dual antiplatelet therapy (DAPT) due to recent coronary artery syndrome treated with coronary stents, while the third was receiving the same treatment for peripheral artery disease managed with a stent. Endobronchial biopsies (EBB) were performed on all three patients without any major complications. CONCLUSION: Although it is typically recommended to discontinue clopidogrel 5-7 days prior to the procedure, early diagnosis and treatment are crucial in certain cases. In these situations, where the benefits may outweigh the risks, EBB can be performed with appropriate precautions. Through our case reports, we aim to encourage further prospective studies and the establishment of updated guidelines, particularly concerning EBB in patients receiving DAPT.
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Rabahoğlu et al. (2025) conducted a case report in Endobronchial lesions in patients on dual antiplatelet therapy (n=3). Endobronchial biopsy while on dual antiplatelet therapy was evaluated on Bleeding complications. Endobronchial biopsy was performed safely without major bleeding complications (only grade 1 bleeding) in three patients receiving dual antiplatelet therapy with clopidogrel and aspirin.
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