Antiplatelet Drugs and Risk of Bleeding After Bedside Pleural Procedures: A National Multicenter Cohort Study.

Autor:	Dangers L; 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., Giovannelli J; CHU Lille, Clinique de Pneumologie, Lille, France; Univ Lille, INSERM, LIRIC UMR U995, Lille, France., Mangiapan G; Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie et Pathologies Professionnelles, Créteil, France., Alves M; APHP, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France; Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Service de Réanimation, Poissy, France., Bigé N; Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Service de Réanimation, Poissy, France., Messika J; APHP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France; Sorbonne Paris Cité, Univ Paris Diderot, INSERM, IAME, UMR 1137, Paris, France., Morawiec E; 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., Neuville M; APHP, Hôpital Bichat-Claude Bernard, Service de Pneumologie, Paris, France., Cracco C; Centre Hospitalier d'Angoulême Saint-Michel, Service de Réanimation Médicale, Saint-Michel, France., Béduneau G; Centre Hospitalier Universitaire de Rouen, Service de Réanimation Médicale, Rouen, France., Terzi N; Centre Hospitalier Universitaire de Caen, Service de Réanimation Médicale, Caen, France., Huet I; Centre Hospitalier Universitaire de Toulouse, Service de Pneumologie, Toulouse, France., Dhalluin X; CHU Lille, Clinique de Pneumologie, Lille, France., Bautin N; CHU Lille, Clinique de Pneumologie, Lille, France; Centre Hospitalier de Roubaix, Service de Pneumologie et Allergologie, Roubaix, France., Quiot JJ; Centre Hospitalier Régional Universitaire de Brest, Département de Médecine Interne et de Pneumologie, Brest, France., Appere-de Vecchi C; Centre Hospitalier Victor Dupouy Argenteuil, Service de Pneumologie, Argenteuil, France., Similowski T; 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., Chenivesse C; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France; CHU Lille, Clinique de Pneumologie, Lille, France; Univ Lille, INSERM, CNRS, Institut Pasteur de Lille, CIIL, U1019, UMR 8204, Lille, France. Electronic address: cecile.chenivesse@chru-lille.fr.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2021 Apr; Vol. 159 (4), pp. 1621-1629. Date of Electronic Publication: 2020 Dec 05.
DOI:	10.1016/j.chest.2020.10.092
Abstrakt:	Background: The 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 Question: Is the risk of bleeding associated with antiplatelet drugs increased in patients undergoing pleural procedures? Study Design and Methods: We 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. Results: A 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. Interpretation: Antiplatelet 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.)
Databáze:	MEDLINE
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