Abstract
Background and Objectives: The application of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been markedly increased over the past decade. EBUS-TBNA is known to be a very safe and accurate procedure; however, the incidence of bleeding complications in patients who are taking antithrombotic agents (ATAs) is not well established. Materials and Methods: We conducted a retrospective analysis of a prospectively registered EBUS-TBNA cohort in a single tertiary hospital from May 2009 to December 2016. The patients were divided into two groups: an insufficient discontinuation group, defined as having a prescription for ATAs on the procedure day or only interrupting them for a short period of time, and a sufficient discontinuation group, defined as having prescription for ATAs during 30 days prior to the procedure and interrupting them for a sufficient period of time. Results: During the study period, a total of 4271 patients, after excluding 3773 patients who did not take ATAs at all, 498 patients were classified into the insufficient discontinuation group (n = 102) and the sufficient discontinuation group (n = 396). The baseline characteristics of patients and examined lesions between two groups were not significantly different, except insufficient discontinuation group had longer prothrombin times than the sufficient discontinuation group. In the insufficient discontinuation group, the most common reasons for prescriptions of ATAs were ischemic heart disease (48.0%) and cerebral vascular disease (28.4%), and half of the patients were taking two or more ATAs. Eventually, only one bleeding complication in the insufficient discontinuation group (1/102, 1.0%) and one event in the sufficient discontinuation group (1/396, 0.3%) occurred (p = 0.368). Conclusions: EBUS-TBNA is considered a safe procedure in terms of bleeding complications, even in patients with insufficient stopping of ATAs.
Highlights
Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a routinely and applicable modality in the diagnosis or staging of pulmonary or mediastinal/hilar diseases, such as cancer, sarcoidosis, or abnormal lymphadenopathy
579 (11.9%) cases simultaneously received endobronchial biopsy (EBB) and/or transbronchial lung biopsy (TBLB), and nine (0.2%) cases without adequate information to identify the history of antithrombotic agents (ATAs) were excluded (Figure 1)
To the best of our knowledge, this is the largest study focused on bleeding complications of EBUS-TBNA
Summary
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a routinely and applicable modality in the diagnosis or staging of pulmonary or mediastinal/hilar diseases, such as cancer, sarcoidosis, or abnormal lymphadenopathy. In the diagnosis and staging of clinical N1-3 non-small cell lung cancer (NSCLC), EBUS-TBNA has shown a diagnostic capability superior to that of mediastinoscopy [4]. Based on these results, as the number of patients requiring EBUS-TBNA increased, patients with multiple comorbidities in need of the procedure increased. EBUSTBNA is known to be a very safe and accurate procedure; the incidence of bleeding complications in patients who are taking antithrombotic agents (ATAs) is not well established. Conclusions: EBUS-TBNA is considered a safe procedure in terms of bleeding complications, even in patients with insufficient stopping of ATAs
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