Patients undergoing thoracentesis
often have comorbid conditions or take medications that potentially put them at higher bleeding
risk. Direct oral anticoagulant (DOAC) use has also increased significantly. There are no published guidelines or consensus on when to perform thoracentesis
in patients on anticoagulants. Recent studies support the safety of a more liberal approach for thoracentesis
among patients with coagulopathy.
We conducted a survey
to ascertain the practices of physicians regarding thoracentesis
in patients with increased bleeding
risk. The survey
was administered to the email distribution lists of the American Association of Bronchology and Interventional Pulmonology and of the American Thoracic Society.
was completed by 256 attending physicians. Most of them were general pulmonologists practicing at academic medical centers. Most of them would perform a thoracentesis
in patients receiving acetylsalicylic acid or prophylactic doses of unfractionated heparin or low molecular weight heparin (96%, 89%, and 88%, respectively). Half of the respondents would perform a thoracentesis
in patients on antiplatelet medications (clopidogrel and ticagrelor, 51%; ticlopidine, 53%). A minority would perform thoracentesis
in patients on direct oral anticoagulants or infused thrombin inhibitors (19% and 12%, respectively). The only subgroup that had a higher proclivity for performing thoracentesis
without holding medications were attending physicians practicing for under 10 years. Relative to noninterventional pulmonologists, there were no significant differences in the responses of interventional pulmonologists.
There was variation in the practice patterns of attending physicians in performing thoracentesis
in patients with elevated bleeding
risk. Further data and guidelines regarding the safety of thoracentesis
in these patients are needed.