53: SAFETY OF PERCUTANEOUS DILATATIONAL TRACHEOSTOMY IN PATIENTS RECEIVING ANTIPLATELET THERAPY

Abstract

Introduction: Tracheostomy is one of the most frequent surgical procedures carried out in critically ill patients. The most popular technique today is the percutaneous dilatational tracheostomy (PDT) which uses serial dilators over a guide wire and is usually done at the bedside in the intensive care unit (ICU) under bronchoscopic guidance. Antiplatelet agents have become a mainstay therapy for vascular diseases; yet they increase the risk of bleeding. The aim of this study is to determine the bleeding risk for patients on antiplatelet therapy who underwent PDT. Methods: A retrospective analysis of patients who underwent PDT admitted to ICU between 2006 and 2021. All data were extracted from electronic health record (EPIC) and operative reports. Minor bleeding is defined as bleeding requiring application of temporary pressure or change of dressing. Major bleeding is defined as bleeding requiring packing with surgicel or transfusion of red blood cells, fresh frozen plasma or platelets. Antiplatelet therapy (APT) is defined as receiving therapy up to and within 24 hours of PDT. Single antiplatelet therapy (SAT) is ASA alone and dual antiplatelet therapy (DAT) is ASA/clopidogrel combination. Results: A total of 677 PDTs were identified and analyzed (567 patients that did not receive antiplatelet therapy [NAT group] and 100 APT group [93 SAT and 17 DAT]). Compared to the NAT group, the APT group were older (71 +/- 12 vs 58 +/- 20, p = 0.0001), had similar gender (male: 60 % vs 60 %, p = 1.0), and similar BMI (29 +/- 9 vs 28 +/- 7, p = 0.2). For minor bleeding (5.1 % in NAT group), the SAT group and DAT group had more bleeding (17 % for SAT, p = 0.0001, and 17.6 % for DAT, p = 0.02). Major bleeding did not significantly differ between SAT and NAT groups (1.1 % vs 0.4 %, p = 0.2), but was significantly higher for DAT group compared to NAT group (5.9 % vs 0.4 %, p = 0.003). Conclusions: In a large single center, there was no significant major bleeding when PDT was performed while patients are on ASA, but there was significantly more major bleeding when patients were on both ASA and clopidogrel. This data should be confirmed in large multicenter prospective studies.