Evaluation of Treatment Adjustments and the Impact of Non-Vitamin K Antagonist Oral Anticoagulants on Complications in Patients Undergoing Diagnostic Bronchoscopy.

UNLABELLED: <p>

Introduction

Non-vitamin K antagonist oral anticoagulants (NOACs) increase the risk of bleeding during invasive procedures such as bronchoscopy. To mitigate this risk, NOACs are typically held before bronchoscopy. Current guidelines for discontinuing NOACs are based on drug half-lives and recommendations from similar invasive procedures. This study aimed to evaluate the safety of our local protocols for pausing NOAC therapy prior to bronchoscopy.

METHODS

We performed a retrospective review of patients treated with NOACs who underwent bronchoscopy with invasive sampling in 2023. We adhered to local guidelines for NOAC discontinuation before procedures with a high bleeding risk. We documented bleeding incidents during bronchoscopy and any potential thromboembolic events, comparing these outcomes with a control group of 75 patients on acetylsalicylic acid (ASA) and 77 patients not on any anticoagulant (ACT) or antiplatelet (APT) therapy.

RESULTS

Out of 1,300 patients who had bronchoscopy in 2023, 100 were on NOACs (48 on rivaroxaban, 36 on apixaban, 12 on dabigatran, and 4 on edoxaban). We further analyzed 75 patients who had invasive sampling: transbronchial biopsy in 49; bronchial biopsy in 12; EBUS-guided transbronchial needle aspiration in 42; and conventional TBNA in 18. Mild to moderate bleeding occurred in 9 of these 75 patients (12%) receiving NOACs, compared to 11 of 75 patients (14.7%) on ASA and 7 of 77 patients (9.1%) without ACT or APT therapy. Bleeding was observed in patients with either lung cancer (n = 16) or interstitial lung disease (n = 10), with one exception. There was no significant association between bleeding and factors such as age, platelet count, or INR levels. No severe bleeding or thromboembolic events were reported in any of the groups.

CONCLUSION

Following local recommendations for NOAC discontinuation before bronchoscopy is effective in minimizing complications and ensuring patient safety during invasive procedures. </p>.