%0 Journal Article
%T Percutaneous pleural drainage in patients taking clopidogrel: real  danger or phantom fear?
%A Katherine Linder
%A Oleg Epelbaum
%J SCIE-indexed Journal
%D 2018
%R 10.21037/jtd.2018.04.161
%X The hesitation on the part of many in the interventional pulmonology community to perform percutaneous pleural drainage in patients receiving clopidogrel is an extrapolation of traditional surgical concerns about operating on patients in the setting of profound platelet inhibition. When it comes to hemostasis, the surgeon¡¯s situation is both comparatively advantageous and disadvantageous. On the one hand, surgery is a more radical intervention than a percutaneous procedure with the possibility of major vascular injury. On the other hand, the surgeon has better access to the site of iatrogenic bleeding and has the technical ability to achieve hemostasis by means of immediate operative repair. Solving this problem by suspending clopidogrel therapy constitutes a potentially significant safety compromise, especially in patients who have undergone recent coronary stenting. Moreover, pleural drainage is often urgent enough to preclude the possibility of delaying it until the effect of clopidogrel dissipates. In the current era of routine ultrasound (US) guidance and shift to smaller tubes, the possibility that percutaneous pleural drainage can be performed safely while continuing clopidogrel is being raised increasingly in interventional pulmonology circles (1). In this review, we familiarize the reader with the pharmacology of clopidogrel, review the risks posed by its periprocedural discontinuation, discuss potentially applicable data from the thoracic surgery and interventional radiology literature, and summarize the available studies of percutaneous pleural drainage in those taking clopidogrel. Finally, we attempt to draw conclusions for clinical practice based on the totality of current evidence
%U http://jtd.amegroups.com/article/view/21697/html