Key result
Antiplatelet therapy linked to ~313% higher bleeding risk within 24 hours after pleural procedures.
Why the study?
Decisions on continuing or withdrawing antiplatelet drugs before pleural procedures balance bleeding and thrombotic risks, but knowledge regarding bleeding risk associated with antiplatelet therapy after pleural procedures is lacking.
Does antiplatelet therapy increase the risk of bleeding in patients undergoing pleural procedures?
Cohort (n=1,124)
Yes
Does antiplatelet therapy increase the risk of bleeding in patients undergoing pleural procedures?
Odds Ratio: 4.13 (95% CI 1.01–17.03)
Absolute Event Rate: 3.23% vs 0.96%
p-value: p=.044
Antiplatelet therapy significantly increases the risk of bleeding and serious bleeding following bedside pleural procedures.
May warrant periprocedural caution with antiplatelet therapy; hypothesis-generating and requires prospective confirmation before practice change.
BACKGROUND: The decision-making on antiplatelet drug withdrawal or continuation before performing a pleural procedure is based on the balance between the risk of bleeding associated with the antiplatelet therapy and the risk of arterial thrombosis due to its interruption. Knowledge on antiplatelet therapy-associated risk of bleeding after pleural procedures is lacking. RESEARCH QUESTION: Is the risk of bleeding associated with antiplatelet drugs increased in patients undergoing pleural procedures? STUDY DESIGN AND METHODS: We conducted a French multicenter cohort study in 19 centers. The main outcome was the occurrence of bleeding, defined as hematoma, hemoptysis, or hemothorax, during the 24 h following a pleural procedure. Serious bleeding events were defined as bleeding requiring blood transfusion, respiratory support, endotracheal intubation, embolization, or surgery, or as death. RESULTS: A total of 1,124 patients was included (men, 66%; median age, 62.6 ± 27.7 years), of whom 182 were receiving antiplatelet therapy and 942 were not. Fifteen patients experienced a bleeding event, including eight serious bleeding events. The 24-h incidence of bleeding was 3.23% (95% CI, 1.08%-5.91%) in the antiplatelet group and 0.96% (95% CI, 0.43%-1.60%) in the control group. The occurrence of bleeding events was significantly associated with antiplatelet therapy in univariate analysis (OR, 3.44; 95% CI, 1.14-9.66; P = .021) and multivariate analysis (OR, 4.13; 95% CI, 1.01-17.03; P = .044) after adjusting for demographic data and the main risk factors for bleeding. Likewise, antiplatelet therapy was significantly associated with serious bleeding in univariate analysis (OR, 8.61; 95% CI, 2.09-42.3; P = .003) and multivariate analysis (OR, 7.27; 95% CI, 1.18-56.1; P = .032) after adjusting for the number of risk factors for bleeding. INTERPRETATION: Antiplatelet therapy was associated with an increased risk of post-pleural procedure bleeding and serious bleeding. Future guidelines should take into account these results for patient safety.
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Dangers et al. (2020) conducted a cohort in Patients undergoing pleural procedures (n=1,124). Antiplatelet therapy vs. No antiplatelet therapy was evaluated on Occurrence of bleeding (hematoma, hemoptysis, or hemothorax) during the 24 h following a pleural procedure (OR 4.13, 95% CI 1.01-17.03, p=.044). Antiplatelet therapy increased the risk of bleeding within 24 hours after pleural procedures compared to no therapy (3.23% vs 0.96%; adjusted OR 4.13; 95% CI 1.01-17.03; P=0.044).
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