Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada; Department of Radiology, Mayo Clinic School of Medicine, Rochester, MN.
Department of Radiology, Mayo Clinic School of Medicine, Rochester, MN.
Chest. 2013 Aug;144(2):456-463. doi: 10.1378/chest.12-2374.
Despite a low incidence of hemorrhagic complications following thoracentesis, correction or attempted correction of abnormal preprocedural coagulation parameters is still commonly performed. We aimed to assess hemorrhagic complications following ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters.
We analyzed 1,009 ultrasound-guided thoracenteses performed between January 2005 and September 2011 on patients with international normalized ratio (INR) > 1.6, serum platelet values < 50 × 109/L, or both. Procedures were divided into two groups: those in whom abnormal preprocedural coagulation parameters were not corrected before the thoracentesis (group 1) and a second group in which patients received a transfusion of platelets or fresh frozen plasma prior to thoracentesis (group 2). All procedures were evaluated for hemorrhagic complications as defined by the National Institutes of Health Common Terminology Criteria for Adverse Events.
A total of 1,009 ultrasound-guided thoracenteses were included in our study, consisting of 706 procedures in 538 patients in group 1 and 303 procedures in 235 patients in group 2. There were four hemorrhagic complications out of 1,009 procedures (0.40%; 95% CI, 0.15%-1.02%): zero in group 1 (0 of 706 or 0.0%; 95% CI, 0%-0.68%) and four in group 2 (four of 303 or 1.32%; 95% CI, 0.51%-3.36%).
Hemorrhagic complications are infrequent after ultrasound-guided thoracentesis, and attempting to correct an abnormal INR or platelet level before the procedure is unlikely to confer any benefit. We consider the procedure safe in patients with abnormal preprocedural parameters when performed by expert personnel.
尽管经皮穿刺术（thoracentesis）后发生出血并发症的发生率较低，但仍常纠正或尝试纠正异常的术前凝血参数。我们旨在评估异常术前凝血参数的患者行超声引导下经皮穿刺术（thoracentesis）后的出血并发症。
我们分析了 2005 年 1 月至 2011 年 9 月间，国际标准化比值（INR）>1.6、血清血小板值<50×109/L 或两者兼有的患者进行的 1009 例超声引导下经皮穿刺术。将操作分为两组：未在经皮穿刺术（thoracentesis）前纠正异常术前凝血参数的患者（组 1）和第二组，在经皮穿刺术（thoracentesis）前接受血小板或新鲜冷冻血浆输注的患者（组 2）。所有操作均按照美国国立卫生研究院不良事件常用术语标准（National Institutes of Health Common Terminology Criteria for Adverse Events）评估出血并发症。
我们的研究共纳入了 1009 例超声引导下经皮穿刺术，其中 706 例为组 1的 538 例患者，303 例为组 2 的 235 例患者。1009 例操作中共有 4 例发生出血并发症（0.40%；95%CI，0.15%-1.02%）：组 1 中 0 例（0/706，0.0%；95%CI，0%-0.68%），组 2 中 4 例（4/303，1.32%；95%CI，0.51%-3.36%）。
超声引导下经皮穿刺术（thoracentesis）后出血并发症并不常见，且在术前尝试纠正异常 INR 或血小板水平可能不会带来任何益处。当由专家人员进行时，我们认为该程序在异常术前参数的患者中是安全的。
