Chest
Volume 129, Issue 3, March 2006, Pages 734-737
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Original Research: INTERVENTIONAL PULMONOLOGY
Effect of Routine Clopidogrel Use on Bleeding Complications After Transbronchial Biopsy in Humans

https://doi.org/10.1378/chest.129.3.734Get rights and content

Study objectives:

Clopidogrel is often prescribed for primary or secondary prevention of cardiovascular disease and has been associated with unwanted bleeding events. After having shown that transbronchial biopsy can safely be performed in pigs receiving clopidogrel, we sought to determine whether routine clopidogrel use increases the risk of bleeding after transbronchial lung biopsy in humans.

Patients and interventions:

Data were collected on 604 patients without underlying coagulation problems who underwent transbronchial lung biopsy over 13 months. Clopidogrel was not discontinued before biopsy in patients who were using it. Transbronchial biopsies were performed, and the incidence of bleeding and other complications among patients receiving clopidogrel was compared with that of other patients.

Results:

The study was stopped early because the bleeding rate in the clopidogrel-only group (n = 18) was excessive (89% [16 of 18 patients] vs 3.4% [20 of 574 control subjects; p > 0.001] and also in the group receiving clopidogrel and aspirin (100% [12 of 12 patients] vs 3.4% among control subjects [p > 0.001]. Bleeding rates were significantly higher in the clopidogrel group for each degree of bleeding severity: mild (27% vs 1.5%), moderate (34% vs 1.5%), and severe (27% vs 0.3%; p > 0.001 for all comparisons). All 12 patients receiving both aspirin and clopidogrel had bleeding: moderate in 6 patients and severe in 6 patients. All bleeding was controlled by endoscopic means. There were no fatalities or need for blood transfusions in the patients enrolled in the trial.

Conclusions:

Clopidogrel use greatly increases the risk of bleeding after transbronchial lung biopsy in humans and therefore should be discontinued before bronchoscopy with biopsies. Aspirin exacerbates the effect of clopidogrel on bleeding.

Section snippets

Materials and Methods

The study was approved by the Institutional Review Board, and all patients gave written informed consent to the bronchoscopy and biopsy procedures.

Results

The study was stopped after 6 months because the bleeding rates in the clopidogrel group were excessive. Until the time of the planned interim analysis, 604 eligible patients had agreed to participate in the study. Of these, 30 patients (5%) had used clopidogrel within 24 h of the bronchoscopy; all were using it daily and continued to do so after the biopsy. The most common reason for using clopidogrel was primary or secondary prevention of coronary heart disease and prevention of graft

Discussion

Pulmonologists frequently encounter patients who require transbronchial lung biopsy with flexible bronchoscopy and who are receiving antiplatelet drugs. We previously found that aspirin alone is not associated with an increase in bleeding complications from transbronchial lung biopsy and therefore does not need to be stopped before this procedure.

These data cannot be generalized to clopidogrel use because its mechanism of action differs from that of aspirin. The results in this trial were not

Conclusions

Routine clopidogrel use greatly increases the risk of bleeding after transbronchial lung biopsy and therefore should be discontinued before this procedure.

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