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Herman DD, Thomson CC, Brosnhan S, Patel R, Trosini-Desert V, Bilaceroglu S, Poston JT, Liberman M, Shah PL, Ost DE, Chatterjee R, Michaud GC. Risk of bleeding in patients undergoing pulmonary procedures on antiplatelet or anticoagulants: A systematic review. Respir Med 2019; 153:76-84. [PMID: 31176274 DOI: 10.1016/j.rmed.2019.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/28/2019] [Indexed: 01/22/2023]
Abstract
As many as 25% of all patients undergoing invasive pulmonary procedures are receiving at least one antiplatelet or anticoagulant agent. For those undergoing elective procedures, the decision-making process is uncomplicated and the procedure may be postponed until the antiplatelet or anticoagulant agent may be safely held. However, many invasive pulmonary procedures are semi-elective or emergent in nature in which case a risk-benefit calculation and discussion occur between the provider and patient or surrogate decision-maker. Therefore, it is critical for providers to have an awareness of the risk of bleeding complications with different pulmonary procedures on various antiplatelet and anticoagulant agents. This systematic review summarizes the bleeding complications associated with different pulmonary procedures in patients on various antiplatelet or anticoagulant agents in the literature and reveals a paucity of high-quality evidence across a wide spectrum of pulmonary procedures and antiplatelet or anticoagulant agents. The results of this review can help inform providers of the bleeding risk in these patients to aid in the shared decision-making process and risk vs benefit discussion.
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Affiliation(s)
- D D Herman
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ohio State University, 201L Dorothy M. Davis Heart & Lung Research Institute, 473W. 12th Avenue, Columbus, OH, 43210, USA.
| | - C C Thomson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Auburn Hospital, 300 Mt Auburn St #419, Cambridge, MA, 02138, USA
| | - S Brosnhan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, NYU Lagone Health, 550 1st, Avenue New York, New York, 10016, USA
| | - R Patel
- Departments of Critical Care Medicine and Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, USA
| | - V Trosini-Desert
- Service de Pneumologie et Réanimation, Unité d'Endoscopie Bronchique, Groupe Hospitalier Pitié Salpétrière, 7 Avenue de la République, 94200, Ivry-sur-Seine, France
| | - S Bilaceroglu
- Department of Pulmonary Medicine, Izmir Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Health Sciences University, 35110, Yenisehir, Izmir, Turkey
| | - J T Poston
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - M Liberman
- Division of Thoracic Surgery, CHUM Endoscospic Tracheobronchial and Oesophageal Center, Department of Surgery, University of Montreal, 1560 rue Sherbrooke Est 8e CD - Pavillon Lachapelle, Bureau D, 8051, Montréal, Québec, H2L 4M1, Canada
| | - P L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom National Heart & Lung Institute, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - D E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 853, Houston, TX, 77030,, USA
| | - R Chatterjee
- Brooke Army Medical Center, 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, Texas, 78234, USA
| | - G C Michaud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, NYU Lagone Health, 530 1st Avenue, HCC, Suite 5D, New York, NY, 10016, USA
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Sanz-Santos J, Serra P, Torky M, Andreo F, Centeno C, Mendiluce L, Martínez-Barenys C, López de Castro P, Ruiz-Manzano J. Systematic Compared With Targeted Staging With Endobronchial Ultrasound in Patients With Lung Cancer. Ann Thorac Surg 2018; 106:398-403. [PMID: 29630875 DOI: 10.1016/j.athoracsur.2018.02.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/15/2018] [Accepted: 02/26/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND To evaluate the accuracy of systematic mediastinal staging by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) (sampling of all visible nodes measuring ≥5 mm from stations N3 to N1 regardless of their positron emission tomography/computed tomography [PET/CT] features) and compare this staging approach with targeted EBUS-TBNA staging (sampling only 18F-fluorodeoxyglucose [FDG]-avid nodes) in patients with N2 non-small cell lung cancer on PET/CT. METHODS Retrospective study of 107 patients who underwent systematic EBUS-TBNA mediastinal staging. The results were compared with those of a hypothetical scenario where only FDG-avid nodes on PET/CT would be sampled. RESULTS Systematic EBUS-TBNA sampling demonstrated N3 disease in 3 patients, N2 disease in 60 (42 single-station or N2a, 18 multiple-station or N2b) and N0/N1 disease in 44. Of these 44, 7 underwent mediastinoscopy, which did not show mediastinal disease; 6 of the 7 proceeded to lung resection, which also showed no mediastinal disease. Thirty-four N0/N1 patients after EBUS-TBNA underwent lung resection directly: N0/N1 was found in 30 and N2 in 4 (1 N2b with a PET/CT showing N2a disease, 3 N2a). Sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy of systematic EBUS-TBNA were 94%, 100%, 90%, 100% and 96%, respectively. Compared with targeted EBUS-TBNA, systematic EBUS-TBNA sampling provided additional important clinical information in 14 cases (13%): 3 N3 cases would have passed unnoticed, and 11 N2b cases would have been staged as N2a. CONCLUSIONS In clinical practice, systematic sampling of the mediastinum by EBUS-TBNA, regardless of PET/CT features, is to be recommended over targeted sampling.
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Affiliation(s)
- José Sanz-Santos
- Bronchoscopy Unit, Pulmonology Department, Hospital Germans Trias i Pujol, Badalona, Spain; Pulmonology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain.
| | - Pere Serra
- Bronchoscopy Unit, Pulmonology Department, Hospital Germans Trias i Pujol, Badalona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Cerdanyola, Spain
| | - Mohamed Torky
- Bronchoscopy Unit, Pulmonology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Felipe Andreo
- Bronchoscopy Unit, Pulmonology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carmen Centeno
- Bronchoscopy Unit, Pulmonology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Leire Mendiluce
- Bronchoscopy Unit, Pulmonology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | | | - Juan Ruiz-Manzano
- Bronchoscopy Unit, Pulmonology Department, Hospital Germans Trias i Pujol, Badalona, Spain
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