Safety of ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters

Rebecca M. Hibbert, Thomas D. Atwell, Alexander Lekah, Maitray D. Patel, Rickey E. Carter, Jennifer S McDonald, Jeffrey T. Rabatin

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: Despite a low incidence of hemorrhagic complications following thoracentesis, correction or attempted correction of abnormal preprocedural coagulation parameters is still commonly performed. We aimed to assess hemorrhagic complications following ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters. Methods: We analyzed 1,009 ultrasound-guided thoracenteses performed between January 2005 and September 2011 on patients with international normalized ratio (INR) . 1.6, serum platelet values < 50 × 109 /L, or both. Procedures were divided into two groups: those in whom abnormal preprocedural coagulation parameters were not corrected before the thoracentesis (group 1) and a second group in which patients received a transfusion of platelets or fresh frozen plasma prior to thoracentesis (group 2). All procedures were evaluated for hemorrhagic complications as defi ned by the National Institutes of Health Common Terminology Criteria for Adverse Events. Results: A total of 1,009 ultrasound-guided thoracenteses were included in our study, consisting of 706 procedures in 538 patients in group 1 and 303 procedures in 235 patients in group 2. There were four hemorrhagic complications out of 1,009 procedures (0.40%; 95% CI, 0.15%-1.02%): zero in group 1 (0 of 706 or 0.0%; 95% CI, 0%-0.68%) and four in group 2 (four of 303 or 1.32%; 95% CI, 0.51%-3.36%). Conclusions: Hemorrhagic complications are infrequent after ultrasound-guided thoracentesis, and attempting to correct an abnormal INR or platelet level before the procedure is unlikely to confer any benefi t. We consider the procedure safe in patients with abnormal preprocedural parameters when performed by expert personnel.

Original languageEnglish (US)
Pages (from-to)456-463
Number of pages8
JournalChest
Volume144
Issue number2
DOIs
StatePublished - Aug 2013

Fingerprint

Safety
International Normalized Ratio
Blood Platelets
Platelet Transfusion
Thoracentesis
National Institutes of Health (U.S.)
Terminology
Incidence
Serum

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Safety of ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters. / Hibbert, Rebecca M.; Atwell, Thomas D.; Lekah, Alexander; Patel, Maitray D.; Carter, Rickey E.; McDonald, Jennifer S; Rabatin, Jeffrey T.

In: Chest, Vol. 144, No. 2, 08.2013, p. 456-463.

Research output: Contribution to journalArticle

Hibbert, Rebecca M. ; Atwell, Thomas D. ; Lekah, Alexander ; Patel, Maitray D. ; Carter, Rickey E. ; McDonald, Jennifer S ; Rabatin, Jeffrey T. / Safety of ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters. In: Chest. 2013 ; Vol. 144, No. 2. pp. 456-463.
@article{95f6955144c442f7a812eab02b37585e,
title = "Safety of ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters",
abstract = "Background: Despite a low incidence of hemorrhagic complications following thoracentesis, correction or attempted correction of abnormal preprocedural coagulation parameters is still commonly performed. We aimed to assess hemorrhagic complications following ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters. Methods: We analyzed 1,009 ultrasound-guided thoracenteses performed between January 2005 and September 2011 on patients with international normalized ratio (INR) . 1.6, serum platelet values < 50 × 109 /L, or both. Procedures were divided into two groups: those in whom abnormal preprocedural coagulation parameters were not corrected before the thoracentesis (group 1) and a second group in which patients received a transfusion of platelets or fresh frozen plasma prior to thoracentesis (group 2). All procedures were evaluated for hemorrhagic complications as defi ned by the National Institutes of Health Common Terminology Criteria for Adverse Events. Results: A total of 1,009 ultrasound-guided thoracenteses were included in our study, consisting of 706 procedures in 538 patients in group 1 and 303 procedures in 235 patients in group 2. There were four hemorrhagic complications out of 1,009 procedures (0.40{\%}; 95{\%} CI, 0.15{\%}-1.02{\%}): zero in group 1 (0 of 706 or 0.0{\%}; 95{\%} CI, 0{\%}-0.68{\%}) and four in group 2 (four of 303 or 1.32{\%}; 95{\%} CI, 0.51{\%}-3.36{\%}). Conclusions: Hemorrhagic complications are infrequent after ultrasound-guided thoracentesis, and attempting to correct an abnormal INR or platelet level before the procedure is unlikely to confer any benefi t. We consider the procedure safe in patients with abnormal preprocedural parameters when performed by expert personnel.",
author = "Hibbert, {Rebecca M.} and Atwell, {Thomas D.} and Alexander Lekah and Patel, {Maitray D.} and Carter, {Rickey E.} and McDonald, {Jennifer S} and Rabatin, {Jeffrey T.}",
year = "2013",
month = "8",
doi = "10.1378/chest.12-2374",
language = "English (US)",
volume = "144",
pages = "456--463",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "2",

}

TY - JOUR

T1 - Safety of ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters

AU - Hibbert, Rebecca M.

AU - Atwell, Thomas D.

AU - Lekah, Alexander

AU - Patel, Maitray D.

AU - Carter, Rickey E.

AU - McDonald, Jennifer S

AU - Rabatin, Jeffrey T.

PY - 2013/8

Y1 - 2013/8

N2 - Background: Despite a low incidence of hemorrhagic complications following thoracentesis, correction or attempted correction of abnormal preprocedural coagulation parameters is still commonly performed. We aimed to assess hemorrhagic complications following ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters. Methods: We analyzed 1,009 ultrasound-guided thoracenteses performed between January 2005 and September 2011 on patients with international normalized ratio (INR) . 1.6, serum platelet values < 50 × 109 /L, or both. Procedures were divided into two groups: those in whom abnormal preprocedural coagulation parameters were not corrected before the thoracentesis (group 1) and a second group in which patients received a transfusion of platelets or fresh frozen plasma prior to thoracentesis (group 2). All procedures were evaluated for hemorrhagic complications as defi ned by the National Institutes of Health Common Terminology Criteria for Adverse Events. Results: A total of 1,009 ultrasound-guided thoracenteses were included in our study, consisting of 706 procedures in 538 patients in group 1 and 303 procedures in 235 patients in group 2. There were four hemorrhagic complications out of 1,009 procedures (0.40%; 95% CI, 0.15%-1.02%): zero in group 1 (0 of 706 or 0.0%; 95% CI, 0%-0.68%) and four in group 2 (four of 303 or 1.32%; 95% CI, 0.51%-3.36%). Conclusions: Hemorrhagic complications are infrequent after ultrasound-guided thoracentesis, and attempting to correct an abnormal INR or platelet level before the procedure is unlikely to confer any benefi t. We consider the procedure safe in patients with abnormal preprocedural parameters when performed by expert personnel.

AB - Background: Despite a low incidence of hemorrhagic complications following thoracentesis, correction or attempted correction of abnormal preprocedural coagulation parameters is still commonly performed. We aimed to assess hemorrhagic complications following ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters. Methods: We analyzed 1,009 ultrasound-guided thoracenteses performed between January 2005 and September 2011 on patients with international normalized ratio (INR) . 1.6, serum platelet values < 50 × 109 /L, or both. Procedures were divided into two groups: those in whom abnormal preprocedural coagulation parameters were not corrected before the thoracentesis (group 1) and a second group in which patients received a transfusion of platelets or fresh frozen plasma prior to thoracentesis (group 2). All procedures were evaluated for hemorrhagic complications as defi ned by the National Institutes of Health Common Terminology Criteria for Adverse Events. Results: A total of 1,009 ultrasound-guided thoracenteses were included in our study, consisting of 706 procedures in 538 patients in group 1 and 303 procedures in 235 patients in group 2. There were four hemorrhagic complications out of 1,009 procedures (0.40%; 95% CI, 0.15%-1.02%): zero in group 1 (0 of 706 or 0.0%; 95% CI, 0%-0.68%) and four in group 2 (four of 303 or 1.32%; 95% CI, 0.51%-3.36%). Conclusions: Hemorrhagic complications are infrequent after ultrasound-guided thoracentesis, and attempting to correct an abnormal INR or platelet level before the procedure is unlikely to confer any benefi t. We consider the procedure safe in patients with abnormal preprocedural parameters when performed by expert personnel.

UR - http://www.scopus.com/inward/record.url?scp=84881508906&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84881508906&partnerID=8YFLogxK

U2 - 10.1378/chest.12-2374

DO - 10.1378/chest.12-2374

M3 - Article

C2 - 23493971

AN - SCOPUS:84881508906

VL - 144

SP - 456

EP - 463

JO - Chest

JF - Chest

SN - 0012-3692

IS - 2

ER -