Abstract

Background Periprocedural management of aspirin and clopidogrel, antiplatelet agents, for Endobronchial Ultrasound with Transbronchial Needle Aspiration (EBUS-TBNA) remains unclear. Discontinuation of antiplatelet therapy has been questioned given the low risk of hemorrhagic complications reported with this procedure. This study evaluated bleeding events following EBUS-TBNA in patients exposed to Dual Antiplatelet Therapy (DAPT), clopidogrel, or Aspirin (ASA) less than seven days prior to procedure compared to patients unexposed to antiplatelet medications. Methods Retrospective analysis was conducted on patient's ≥ 18 years who underwent inpatient EBUS-TBNA between 1 January 2009 and 31 December 2014. Results 406 patients were evaluated: DAPT n = 23; ASA n = 99; clopidogrel n = 13; unexposed n = 271. Bleeding events occurred in 2.5% of patients: DAPT n = 2 (8.7%); ASA n = 0 (0%); clopidogrel n = 1 (7.7%); unexposed n = 7 (2.6%), p = 0.05. Exposed patients were more likely to experience hemoglobin drop > 2 g: DAPT 4.3% Vs. clopidogrel 7.7% Vs. unexposed 0.7%, p = 0.02. Patients taking DAPT were more likely to be readmitted in 48 hours for hemoptysis or anemia: DAPT 4.3% Vs. unexposed 0.4%, p = 0.06. Conclusion Patients exposed to DAPT/clopidogrel who undergo EBUS-TBNA are more likely to experience delayed bleeding events within 48 hrs of procedure; however, risk of significant bleeding requiring procedural or transfusion intervention is low. Careful operator assessment of individualized risk versus benefit of antiplatelet therapy continuation must occur prior to EBUS-TBNA procedure.

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