title: The safety of thoracentesis in patients with uncorrected bleeding risk.
abstract: BACKGROUND
  Thoracentesis is commonly performed to evaluate pleural effusions. Many medications (warfarin, heparin, clopidogrel) or physiological factors (elevated International Normalized Ratio [INR], thrombocytopenia, uremia) increase the risk for bleeding. Frequently these medications are withheld or transfusions are performed to normalize physiological parameters before a procedure. The safety of performing thoracentesis without correction of these bleeding risks has not been prospectively evaluated.
  
  
  METHODS
  This prospective observational cohort study enrolled 312 patients who underwent thoracentesis. All patients were evaluated for the presence of risk factors for bleeding. Hematocrit levels were obtained pre- and postprocedure, and the occurrence of postprocedural hemothorax was evaluated.
  
  
  RESULTS
  Thoracenteses were performed in 312 patients, 42% of whom had a risk for bleeding. Elevated INR, secondary to liver disease or warfarin, and renal disease were the two most common etiologies for bleeding risk, although many patients had multiple potential bleeding risks. There was no significant difference in pre- and postprocedural hematocrit levels in patients with a bleeding risk when compared with patients with no bleeding risk. No patient developed a hemothorax as a result of the thoracentesis.
  
  
  CONCLUSIONS
  This single-center, observational study suggests that thoracentesis may be safely performed without prior correction of coagulopathy, thrombocytopenia, or medication-induced bleeding risk. This may reduce the morbidity associated with transfusions or withholding of medications.
authors: Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. Jonathan.puchalski@yale.edu
authors: Jonathan T
authors: JT
authors: Puchalski
authors: A Christine
authors: AC
authors: Argento
authors: Terrence E
authors: TE
authors: Murphy
authors: Katy L B
authors: KL
authors: Araujo
authors: Margaret A
authors: MA
authors: Pisani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000209:etiology; D000077144:Clopidogrel; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D005260:Female; D048550:Hepatic Insufficiency / Q000150:complications; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010996:Pleural Effusion / Q000150:complications / Q000601:surgery*; D019106:Postoperative Hemorrhage; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012307:Risk Factors; D013921:Thrombocytopenia / Q000209:etiology; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine
references: Curr Opin Pulm Med. 2007 Jul;13(4):312-8
references: 17534178
references: Cancer. 2007 May 1;109(9):1705-14
references: 17366593
references: Ann Thorac Surg. 2011 Dec;92(6):1971-6
references: 21978871
references: Transfusion. 2005 Sep;45(9):1413-25
references: 16131373
references: J Thorac Cardiovasc Surg. 2010 Nov;140(5):970-6
references: 20804992
references: Clin Oncol (R Coll Radiol). 2001;13(5):320-1
references: 11716220
references: Respir Med. 2013 Feb;107(2):284-91
references: 23219348
references: Blood Transfus. 2009 Jan;7(1):1-2
references: 19290073
references: Thorax. 2010 Aug;65 Suppl 2:ii61-76
references: 20696688
references: Am J Crit Care. 2007 Jan;16(1):39-48; quiz 49
references: 17192525
references: J Bronchology Interv Pulmonol. 2012 Oct;19(4):284-7
references: 23207527
references: Transfus Clin Biol. 2012 Jun;19(3):125-31
references: 22682308
references: AJR Am J Roentgenol. 2011 Jul;197(1):W164-8
references: 21700980
references: Transfusion. 1991 Feb;31(2):164-71
references: 1996485
references: Chest. 2003 Feb;123(2):418-23
references: 12576360
references: Respir Care. 2010 Nov;55(11):1495-8
references: 20979678
references: Chest. 2012 May;141(5):1139-1142
references: 22553259
references: J Formos Med Assoc. 2010 Aug;109(8):574-81
references: 20708508
references: Chest. 2006 Jun;129(6):1709-14
references: 16778292
references: Ann Thorac Surg. 2007 Nov;84(5):1656-61
references: 17954079
references: J Vasc Interv Radiol. 2012 Jun;23(6):727-36
references: 22513394
references: Arch Intern Med. 1990 Apr;150(4):873-7
references: 2183735
references: Arch Intern Med. 2010 Feb 22;170(4):332-9
references: 20177035
references: J Vasc Interv Radiol. 2009 Jul;20(7 Suppl):S240-9
references: 19394868