Is It Safe to Perform Thoracentesis While Taking Clopidogrel?

Abstract

PURPOSE: Clopidogrel (Plavix), a thienopyridine compound that inhibits adenosine diphosphate-induced platelet aggregation, binds irreversibly to platelets. Aggregation requires 7-10 days to recover as new platelets develop and enter circulation. Recommendations for patients taking clopidogrel who need an invasive intervention such as thoracentesis require holding clopidogrel for five days prior to the procedure. However, discontinuing clopidogrel following coronary intervention may result in high risk of stent thrombosis if therapy is interrupted within 1 month of bare metal stent placement or 12 months for drug-eluting stents. Interruption of clopidogrel therapy in individuals with indications for its use in cerebrovascular, peripheral vascular, and coronary disease is also fraught with danger. METHODS: We performed a retrospective chart review of all patients who underwent thoracentesis from 2008-2011. All patients who were either taking clopidogrel at the time of thoracentesis or had it discontinued prior to performing the procedure were included. Bleeding complications such as chest wall hematoma, hemothorax, or acute drop in hematocrit were recorded, if present. Follow up chest x-rays were reviewed for complications following the procedure. RESULTS: 12 patients received 13 procedures of whom 5 patients had clopidogrel stopped for an average of 5.8 days [range from 4 to 9 days] while 7 patients remained on clopidogrel at the time of the procedure. In both populations, no bleeding complications were noted. Five of the seven patients who remained on clopidogrel had chronic kidney disease while one of the five patients whose clopidogrel was held had chronic kidney disease. INR range for patients who stopped clopidogrel was [1.0-1.3], and [1-1.4] for the group that continued on clopidogrel. Patients whose clopidogrel was held prior to the procedure did not have any acute coronary events or death. CONCLUSIONS: In this small series, the risk of bleeding complications in patients on clopidogrel is not significantly increased during thoracentesis. A randomized controlled study should be performed to confirm these results. If the results of the study are confirmed, withholding clopidogrel for five days prior to thoracentesis may not be necessary, thus reducing the risk of vascular occlusion while obviating delay in performing a necessary procedure.