Hemorrhagic complications of thoracentesis and small-bore chest tube placement in patients taking clopidogrel
Clopidogrel is a commonly used antiplatelet medication. The risk of local hemorrhage associated with use of this drug during routine thoracentesis or small-bore chest tube placement is not well established. We conducted a prospective cohort study to assess the risk of hemothorax in patients taking c...
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| Veröffentlicht in: | Annals of the American Thoracic Society 2014-01, Vol.11 (1), p.73-79 |
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| creator | Mahmood, Kamran Shofer, Scott L Moser, Barry K Argento, A Christine Smathers, Emily C Wahidi, Momen M |
| description | Clopidogrel is a commonly used antiplatelet medication. The risk of local hemorrhage associated with use of this drug during routine thoracentesis or small-bore chest tube placement is not well established.
We conducted a prospective cohort study to assess the risk of hemothorax in patients taking clopidogrel while undergoing either pleural procedure.
Twenty-five consecutive adult patients who were taking clopidogrel at the time they were offered thoracentesis or small-bore (14 Fr) chest tube placement consented to continue taking the drug through their procedure. A control group consisted of 50 patients undergoing these pleural procedures who were not taking clopidogrel at the time they consented to undergo either procedure. All of the pleural procedures were performed under ultrasound guidance by an interventional pulmonologist or a fellow under direct faculty supervision. Hospitalized patients were screened for hemothorax by observing for a post-procedure drop in blood hemoglobin content of 2 g/dl or reaccumulation of their pleural effusion within 24 hours of the procedure. Outpatients were called within 2 weeks after their procedure to determine whether they had any symptoms suggestive of hemothorax.
There was one case of hemothorax after thoracentesis in the clopidogrel group versus none in the control group. The one patient with hemothorax required transfusion with 2 units of packed red blood cells and small-bore chest tube placement, and clopidogrel was withheld. There were no other clinically apparent complications of either procedure.
Considered in combination with other small previously published studies, this single-center, nonrandomized, controlled prospective cohort study suggests that the rate of clinically consequential hemorrhage after ultrasound-guided thoracentesis or chest tube placement in patients taking clopidogrel is sufficiently low to warrant a large, randomized clinical trial designed to determine the safety of performing these procedures without interrupting clopidogrel therapy. |
| doi_str_mv | 10.1513/AnnalsATS.201303-050OC |
| format | Article |
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We conducted a prospective cohort study to assess the risk of hemothorax in patients taking clopidogrel while undergoing either pleural procedure.
Twenty-five consecutive adult patients who were taking clopidogrel at the time they were offered thoracentesis or small-bore (14 Fr) chest tube placement consented to continue taking the drug through their procedure. A control group consisted of 50 patients undergoing these pleural procedures who were not taking clopidogrel at the time they consented to undergo either procedure. All of the pleural procedures were performed under ultrasound guidance by an interventional pulmonologist or a fellow under direct faculty supervision. Hospitalized patients were screened for hemothorax by observing for a post-procedure drop in blood hemoglobin content of 2 g/dl or reaccumulation of their pleural effusion within 24 hours of the procedure. Outpatients were called within 2 weeks after their procedure to determine whether they had any symptoms suggestive of hemothorax.
There was one case of hemothorax after thoracentesis in the clopidogrel group versus none in the control group. The one patient with hemothorax required transfusion with 2 units of packed red blood cells and small-bore chest tube placement, and clopidogrel was withheld. There were no other clinically apparent complications of either procedure.
Considered in combination with other small previously published studies, this single-center, nonrandomized, controlled prospective cohort study suggests that the rate of clinically consequential hemorrhage after ultrasound-guided thoracentesis or chest tube placement in patients taking clopidogrel is sufficiently low to warrant a large, randomized clinical trial designed to determine the safety of performing these procedures without interrupting clopidogrel therapy.</description><identifier>ISSN: 2329-6933</identifier><identifier>EISSN: 2325-6621</identifier><identifier>DOI: 10.1513/AnnalsATS.201303-050OC</identifier><identifier>PMID: 24102190</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject>Aged ; Aged, 80 and over ; Case-Control Studies ; Chest Tubes - adverse effects ; Cohort Studies ; Female ; Hemothorax - etiology ; Humans ; Male ; Middle Aged ; Paracentesis - adverse effects ; Platelet Aggregation Inhibitors - adverse effects ; Pleural Effusion - therapy ; Prospective Studies ; Ticlopidine - adverse effects ; Ticlopidine - analogs & derivatives ; Ultrasonography, Interventional</subject><ispartof>Annals of the American Thoracic Society, 2014-01, Vol.11 (1), p.73-79</ispartof><rights>Copyright American Thoracic Society Jan 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c254t-adb27bfea60442a99bae28bfc135666c2433391cab3a2c6741904414b3181af53</citedby><cites>FETCH-LOGICAL-c254t-adb27bfea60442a99bae28bfc135666c2433391cab3a2c6741904414b3181af53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24102190$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mahmood, Kamran</creatorcontrib><creatorcontrib>Shofer, Scott L</creatorcontrib><creatorcontrib>Moser, Barry K</creatorcontrib><creatorcontrib>Argento, A Christine</creatorcontrib><creatorcontrib>Smathers, Emily C</creatorcontrib><creatorcontrib>Wahidi, Momen M</creatorcontrib><title>Hemorrhagic complications of thoracentesis and small-bore chest tube placement in patients taking clopidogrel</title><title>Annals of the American Thoracic Society</title><addtitle>Ann Am Thorac Soc</addtitle><description>Clopidogrel is a commonly used antiplatelet medication. The risk of local hemorrhage associated with use of this drug during routine thoracentesis or small-bore chest tube placement is not well established.
We conducted a prospective cohort study to assess the risk of hemothorax in patients taking clopidogrel while undergoing either pleural procedure.
Twenty-five consecutive adult patients who were taking clopidogrel at the time they were offered thoracentesis or small-bore (14 Fr) chest tube placement consented to continue taking the drug through their procedure. A control group consisted of 50 patients undergoing these pleural procedures who were not taking clopidogrel at the time they consented to undergo either procedure. All of the pleural procedures were performed under ultrasound guidance by an interventional pulmonologist or a fellow under direct faculty supervision. Hospitalized patients were screened for hemothorax by observing for a post-procedure drop in blood hemoglobin content of 2 g/dl or reaccumulation of their pleural effusion within 24 hours of the procedure. Outpatients were called within 2 weeks after their procedure to determine whether they had any symptoms suggestive of hemothorax.
There was one case of hemothorax after thoracentesis in the clopidogrel group versus none in the control group. The one patient with hemothorax required transfusion with 2 units of packed red blood cells and small-bore chest tube placement, and clopidogrel was withheld. There were no other clinically apparent complications of either procedure.
Considered in combination with other small previously published studies, this single-center, nonrandomized, controlled prospective cohort study suggests that the rate of clinically consequential hemorrhage after ultrasound-guided thoracentesis or chest tube placement in patients taking clopidogrel is sufficiently low to warrant a large, randomized clinical trial designed to determine the safety of performing these procedures without interrupting clopidogrel therapy.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Case-Control Studies</subject><subject>Chest Tubes - adverse effects</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Hemothorax - etiology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Paracentesis - adverse effects</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Pleural Effusion - therapy</subject><subject>Prospective Studies</subject><subject>Ticlopidine - adverse effects</subject><subject>Ticlopidine - analogs & derivatives</subject><subject>Ultrasonography, Interventional</subject><issn>2329-6933</issn><issn>2325-6621</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkT1PwzAQhi0Eogj4C8gSC0uKv-LEY1XxJSF1oMyW7TitwYmDnQz8e9wWOuDFNzzv6e4eAG4wmuMS0_tF3yufFuu3OUGYIlqgEq2WJ-CCUFIWnBN8uq9FwQWlM3Cd0gfKry5xXYlzMCMMI4IFugDds-1CjFu1cQaa0A3eGTW60CcYWjhuQ1TG9qNNLkHVNzB1yvtCh2ih2do0wnHSFg4-U13moOvhkPO5THBUn67fQOPD4JqwidZfgbM2T26vf_9L8P74sF4-F6-rp5fl4rUwpGRjoRpNKt1axRFjRAmhlSW1bg2mJefcEEYpFdgoTRUxvGJ5FcYw0xTXWLUlvQR3h75DDF9THlN2LhnrveptmJLETBAuqqriGb39h36EKe7uK3GZT0Yo43Wm-IEyMaQUbSuH6DoVvyVGcudEHp3IgxO5d5KDN7_tJ93Z5hj7M0B_ANsmins</recordid><startdate>201401</startdate><enddate>201401</enddate><creator>Mahmood, Kamran</creator><creator>Shofer, Scott L</creator><creator>Moser, Barry K</creator><creator>Argento, A Christine</creator><creator>Smathers, Emily C</creator><creator>Wahidi, Momen M</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201401</creationdate><title>Hemorrhagic complications of thoracentesis and small-bore chest tube placement in patients taking clopidogrel</title><author>Mahmood, Kamran ; Shofer, Scott L ; Moser, Barry K ; Argento, A Christine ; Smathers, Emily C ; Wahidi, Momen M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c254t-adb27bfea60442a99bae28bfc135666c2433391cab3a2c6741904414b3181af53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Case-Control Studies</topic><topic>Chest Tubes - adverse effects</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Hemothorax - etiology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Paracentesis - adverse effects</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Pleural Effusion - therapy</topic><topic>Prospective Studies</topic><topic>Ticlopidine - adverse effects</topic><topic>Ticlopidine - analogs & derivatives</topic><topic>Ultrasonography, Interventional</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mahmood, Kamran</creatorcontrib><creatorcontrib>Shofer, Scott L</creatorcontrib><creatorcontrib>Moser, Barry K</creatorcontrib><creatorcontrib>Argento, A Christine</creatorcontrib><creatorcontrib>Smathers, Emily C</creatorcontrib><creatorcontrib>Wahidi, Momen M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of the American Thoracic Society</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mahmood, Kamran</au><au>Shofer, Scott L</au><au>Moser, Barry K</au><au>Argento, A Christine</au><au>Smathers, Emily C</au><au>Wahidi, Momen M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hemorrhagic complications of thoracentesis and small-bore chest tube placement in patients taking clopidogrel</atitle><jtitle>Annals of the American Thoracic Society</jtitle><addtitle>Ann Am Thorac Soc</addtitle><date>2014-01</date><risdate>2014</risdate><volume>11</volume><issue>1</issue><spage>73</spage><epage>79</epage><pages>73-79</pages><issn>2329-6933</issn><eissn>2325-6621</eissn><abstract>Clopidogrel is a commonly used antiplatelet medication. The risk of local hemorrhage associated with use of this drug during routine thoracentesis or small-bore chest tube placement is not well established.
We conducted a prospective cohort study to assess the risk of hemothorax in patients taking clopidogrel while undergoing either pleural procedure.
Twenty-five consecutive adult patients who were taking clopidogrel at the time they were offered thoracentesis or small-bore (14 Fr) chest tube placement consented to continue taking the drug through their procedure. A control group consisted of 50 patients undergoing these pleural procedures who were not taking clopidogrel at the time they consented to undergo either procedure. All of the pleural procedures were performed under ultrasound guidance by an interventional pulmonologist or a fellow under direct faculty supervision. Hospitalized patients were screened for hemothorax by observing for a post-procedure drop in blood hemoglobin content of 2 g/dl or reaccumulation of their pleural effusion within 24 hours of the procedure. Outpatients were called within 2 weeks after their procedure to determine whether they had any symptoms suggestive of hemothorax.
There was one case of hemothorax after thoracentesis in the clopidogrel group versus none in the control group. The one patient with hemothorax required transfusion with 2 units of packed red blood cells and small-bore chest tube placement, and clopidogrel was withheld. There were no other clinically apparent complications of either procedure.
Considered in combination with other small previously published studies, this single-center, nonrandomized, controlled prospective cohort study suggests that the rate of clinically consequential hemorrhage after ultrasound-guided thoracentesis or chest tube placement in patients taking clopidogrel is sufficiently low to warrant a large, randomized clinical trial designed to determine the safety of performing these procedures without interrupting clopidogrel therapy.</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>24102190</pmid><doi>10.1513/AnnalsATS.201303-050OC</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2329-6933 |
| ispartof | Annals of the American Thoracic Society, 2014-01, Vol.11 (1), p.73-79 |
| issn | 2329-6933 2325-6621 |
| language | eng |
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| source | Journals@Ovid Ovid Autoload; MEDLINE; American Thoracic Society (ATS) Journals Online; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Case-Control Studies Chest Tubes - adverse effects Cohort Studies Female Hemothorax - etiology Humans Male Middle Aged Paracentesis - adverse effects Platelet Aggregation Inhibitors - adverse effects Pleural Effusion - therapy Prospective Studies Ticlopidine - adverse effects Ticlopidine - analogs & derivatives Ultrasonography, Interventional |
| title | Hemorrhagic complications of thoracentesis and small-bore chest tube placement in patients taking clopidogrel |
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