• Laurence Dangers, Jonathan Giovannelli, Gilles Mangiapan, Mikael Alves, Naïke Bigé, Jonathan Messika, Elise Morawiec, Mathilde Neuville, Christophe Cracco, Gaëtan Béduneau, Nicolas Terzi, Isabelle Huet, Xavier Dhalluin, Nathalie Bautin, Jean-Jacques Quiot, Appere-de VecchiCorinneCCentre Hospitalier Victor Dupouy Argenteuil, Service de Pneumologie, Argenteuil, France., Thomas Similowski, and Cécile Chenivesse.
• AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
• Chest. 2021 Apr 1; 159 (4): 1621-1629.

BackgroundThe 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 procedures is lacking.Research QuestionIs the risk of bleeding associated with antiplatelet drugs increased in patients undergoing pleural procedures?Study Design And MethodsWe 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 h following a pleural procedure. Serious bleeding events were defined as bleeding requiring blood transfusion, respiratory support, endotracheal intubation, embolization, or surgery, or as death.ResultsA total of 1,124 patients was included (men, 66%; median age, 62.6 ± 27.7 years), of whom 182 were receiving antiplatelet therapy and 942 were not. Fifteen patients experienced a bleeding event, including eight serious bleeding events. The 24-h incidence of bleeding was 3.23% (95% CI, 1.08%-5.91%) in the antiplatelet group and 0.96% (95% CI, 0.43%-1.60%) in the control group. The occurrence of bleeding events was significantly associated with antiplatelet therapy in univariate analysis (OR, 3.44; 95% CI, 1.14-9.66; P = .021) and multivariate analysis (OR, 4.13; 95% CI, 1.01-17.03; P = .044) after adjusting for demographic data and the main risk factors for bleeding. Likewise, antiplatelet therapy was significantly associated with serious bleeding in univariate analysis (OR, 8.61; 95% CI, 2.09-42.3; P = .003) and multivariate analysis (OR, 7.27; 95% CI, 1.18-56.1; P = .032) after adjusting for the number of risk factors for bleeding.InterpretationAntiplatelet 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.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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