Antiplatelet drugs and risk of bleeding after bedside pleural procedures: a national multicenter cohort study

Abstract 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 procedure 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 hours following the pleural procedure. Serious bleedings were defined as bleeding requiring blood transfusion, respiratory support, endotracheal intubation, embolization, surgery or death. Results A total of 1124 patients was included (66% of men, median age of 62.6 ± 27.7 years), of whom 182 were on antiplatelet therapy and 942 were not. Fifteen patients experienced a bleeding event including eight serious bleedings. The 24-hour incidence of bleeding was 3.23% (95% CI, 1.08 to 5.91) in the antiplatelet group and 0.96% (95% CI, 0.43 to 1.60) in the control group. The occurrence of bleeding events was significantly associated with antiplatelet therapy in univariate (OR, 3.44; 95% CI, 1.14 to 9.66; p=0.021) and multivariate analysis (OR, 4.13; 95% CI, 1.01 to 17.03; p=0.044) after adjusting for demographic data and the main risks factors for bleeding. Likewise, antiplatelet therapy was significantly associated with serious bleeding in univariate (OR, 8.61; 95% CI, 2.09 to 42.3; p=0.003) and multivariate analysis (OR, 7.27; 95% CI, 1.18 to 56.1; p=0.032) 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.