Antiplatelet Therapy May Increase Minor Bleeding Events During EBUS-TBNA

After careful consideration, the American Thoracic Society canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from May 15-20, because of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting. A virtual event is being planned for later this year.

While the incidence of minor bleeding events during endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is higher in patients who receive antiplatelet medications, these medications are still warranted in select patients, including those with coronary artery disease (CAD), according to findings intended to be presented at the American Thoracic Society (ATS) International Conference. (Select research is slated to be presented in a virtual format later this year.)

In clinical practice, EBUS-TBNA can be used as a diagnostic tool for lung cancer, lymphadenopathy, and parenchymal lesions that lie close to central airways. This study was a retrospective assessment of 148 patients in the Partners Healthcare system who underwent EBUS-TBNA from 2006 to 2016. Individual charts of patients in the Research Patient Data Registry (RPDR) were used to identify exposure to either clopidogrel or prasugrel with or without concomitant aspirin within 5 days before EBUS-TBNA.

Procedural bleeding was the primary study outcome. Secondary outcomes included were death within 7 days, unexpected hospital admissions, and acute coronary syndrome within 48 hours of EBUS-TBNA. The odds of bleeding were compared between patients who continued and did not continue antiplatelet therapy before EBUS-TBNA.

Overall, 16 patients (10.8%) continued an anti-platelet medication within 5 days of EBUS-TBNA, and 4 of these patients experienced a minor bleeding event during the procedure. Bleeding complications in these patients were not life-threatening and required minor procedural interventions (eg, cold saline lavage or topical epinephrine). 

Minor bleeding events were observed in 5.3% (n=7) of the 132 patients who did not receive an antiplatelet agent within 5 days of EBUS-TBNA. For patients who continued antiplatelet therapy vs those who did not, the adjusted odds ratio of bleeding during EBUS-TBNA was 6.08 (95% CI, 1.52-24.33; P =.01).

In the group of patients who experienced interruption in their antiplatelet medication regimen, 2 patients had postprocedural non-ST elevation myocardial infarction and 1 patient died from a complication associated with acute myocardial infarction.

The investigators suggested that continuation of antiplatelet medications may be important in patients with CAD, considering “the self-limited bleeding complications described and the potential risks of medication interruption such as acute stent thrombosis and death.”

Reference

Rabin A, Krumme AA, Keyes C, Folch EE. Risks associated with anti-platelet medication continuation among patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration. Am J Respir Crit Care Med. 2020;201:A1110.

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