Thoracentesis and tube thoracostomy are common procedures with bleeding risks, but existing guidelines may be overly conservative. We reviewed the evidence on the safety of thoracentesis and tube thoracostomy in patients with uncorrected coagulopathy.Is it safe to perform thoracentesis and tube thoracostomy in patients with uncorrected coagulopathy?This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. PubMed and Embase were searched from inception to 31 December 2019. Included studies involved patients with uncorrected coagulopathy due to disease (e.g. thrombocytopenia, liver cirrhosis, kidney failure) or drugs (e.g. antiplatelets, anticoagulants). Relevant outcomes were major bleeding and mortality.18 studies (5,134 procedures) were included. Using random-effects meta-analysis, the pooled major bleeding and mortality rate was zero (95% CI, 0%-1%). There was no publication bias. Excluding 6 studies which were in abstract form, meta-analysis of the remaining 12 full articles showed that the pooled major bleeding and mortality rate was also zero (95% CI, 0%-2%). Subgroup analysis performed for patients with uncorrected coagulopathy due to disease or drugs showed similar results.Among patients with uncorrected coagulopathy who underwent thoracentesis or tube thoracostomy, major bleeding and mortality complications were uncommon. Our results suggest that in appropriately selected patients, thoracentesis or tube thoracostomy can be safely performed.
Clare Fong, Colin Wei Chang Tan, Drusilla Kai Yan Tan, Kay Choong See