• Clare Fong, TanColin Wei ChangCWCYong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore., TanDrusilla Kai YanDKYYong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore., and Kay Choong See.
• Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University of Singapore, Singapore, Republic of Singapore. Electronic address: clare_fong@nuhs.edu.sg.
• Chest. 2021 Nov 1; 160 (5): 1875-1889.

BackgroundThoracentesis and tube thoracostomy are common procedures with bleeding risks, but existing guidelines may be overly conservative. We reviewed the evidence on the safety of thoracentesis and tube thoracostomy in patients with uncorrected coagulopathy.Research QuestionIs it safe to perform thoracentesis and tube thoracostomy in patients with uncorrected coagulopathy?Study Design And MethodsThis systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. PubMed and Embase were searched from inception through December 31, 2019. Included studies involved patients with uncorrected coagulopathy because of disease (eg, thrombocytopenia, liver cirrhosis, kidney failure) or drugs (eg, antiplatelets, anticoagulants). Relevant outcomes were major bleeding and mortality.ResultsEighteen studies (5,134 procedures) were included. Using random-effects meta-analysis, the pooled major bleeding and mortality rate was 0 (95% CI, 0%-1%). No publication bias was found. Excluding six studies that were in abstract form, meta-analysis of the remaining 12 full articles showed that the pooled major bleeding and mortality rate also was 0 (95% CI, 0%-2%). Subgroup analysis performed for patients with uncorrected coagulopathy resulting from disease or drugs showed similar results.InterpretationAmong patients with uncorrected coagulopathy who underwent thoracentesis or tube thoracostomy, major bleeding and mortality complications were uncommon. Our results suggest that in appropriately selected patients, thoracentesis or tube thoracostomy can be performed safely.Trial RegistryPROSPERO; No.: CRD42020152226; URL: www.crd.york.ac.uk/prospero/.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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