Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905.
Department of General Thoracic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905.
J Vasc Interv Radiol. 2019 Nov;30(11):1765-1768. doi: 10.1016/j.jvir.2019.07.002. Epub 2019 Oct 3.
To evaluate the incidence of major hemorrhage after image-guided percutaneous chest tube placement in patients with an abnormal international normalized ratio (INR) measured before the procedure.
Between January 2013 and September 2017, 49 image-guided percutaneous chest tubes were placed in 45 adult patients who had an elevated INR of greater than 1.6. Data collected included routine serum pre-procedure coagulation studies, indication for chest tube placement, insertion technique, size of chest tube, and presence of complications after drain placement. Major bleeding complications were defined using the Society of Interventional Radiology classification system.
Mean patient age was 62 years (range, 22-94 years), with median American Society of Anesthesiologists score of 4. Mean INR was 2.1 (range, 1.7-3), with 21 (43%) procedures with an INR between 1.7 and 1.9, 20 (41%) procedures with an INR between 2.0 and 2.4, and 8 (16%) procedures with an INR between 2.5 and 3.0. Computed tomography guidance was used for 27 (55%) procedures; ultrasound guidance was used for 22 (45%) procedures. Median size of chest tube was 10 Fr (range, 8-14 Fr) used in 27 (55%) procedures. No major bleeding complications were observed. There was a small, significant decrease in mean hemoglobin after the procedure (mean = 0.9g/dL; P < .0001), which correlated to increasing chest tube size (P = .0269).
No major bleeding complications were observed after image-guided percutaneous chest tube placement in patients with an elevated INR. Major bleeding complications in these patients may be safer than initially considered, and this study encourages the conduct of larger trials for further evaluation.
评估在术前国际标准化比值（INR）异常的患者中行影像引导经皮胸部置管后发生大出血的发生率。
2013 年 1 月至 2017 年 9 月，对 45 例 INR 高于 1.6 的成年患者进行了 49 例影像引导经皮胸部置管，收集了包括术前常规凝血检查、置管适应证、置管技术、引流管大小以及置管后并发症等数据。主要出血并发症采用介入放射学学会（SIR）分类系统定义。
患者平均年龄 62 岁（范围，22-94 岁），平均美国麻醉医师协会（ASA）评分 4 分。INR 均值为 2.1（范围，1.7-3），21 例（43%）INR 在 1.7-1.9 之间，20 例（41%）INR 在 2.0-2.4 之间，8 例（16%）INR 在 2.5-3.0 之间。27 例（55%）采用 CT 引导，22 例（45%）采用超声引导。27 例（55%）使用 10Fr 引流管（范围，8-14Fr）。未观察到重大出血并发症。术后平均血红蛋白水平显著下降（0.9g/dL，P<.0001），与引流管大小呈正相关（P=.0269）。
在 INR 升高的患者中行影像引导经皮胸部置管后未观察到重大出血并发症。这些患者发生重大出血并发症的风险可能比最初认为的要低，本研究鼓励进行更大规模的试验以进一步评估。
