Authors (including presenting author) :
Stefanie W.Y. Yip(1), Tom C.Y. Cheung(1), Carmen C.M. Cho(1), Chris S.C. Tsai(1), K.T. Wong(1), Risa Ozaki(2), Heyson C.H. Chan(2), Agnes S.M. Choy(2), K.M. Chow(2)
Affiliation :
(1)Department of Imaging and Interventional Radiology, Prince of Wales Hospital (2)Department of Medicine, Prince of Wales Hospital
Introduction :
Ultrasound(US)-guided pleural and abdominal drainage is the commonest interventional radiology procedure performed in our centre and is classified as low bleeding-risk procedure. International guidelines indicate that INR of <2.0 and platelet count >20x10^9/L are sufficient to perform these low-bleeding risk procedures, but most HA institutions routinely require correcting INR to <1.5 and platelet to >50x10^9/L before proceeding.
Objectives :
To determine if it is safe to relax hospital-based hemostasis guidelines for performing these low-bleeding risk procedures to INR of <2.0 and platelet count >20x10^9/L.
Methodology :
853 US-guided pleural and abdominal drainage procedures were performed in our institution’s interventional radiology department during the 6-month period of April 1, 2021-September 30, 2021. Each case was retrospectively reviewed for any procedural-related bleeding complications and the INR and platelet counts were recorded. Pleural biopsy cases were excluded as those are high bleeding-risk procedures.
Result & Outcome :
The overall complication rate of US-guided pleural and abdominal drainage procedures was 0.35%(3/853), which is well–within the quality assurance threshold for low bleeding-risk procedure of 2%. The 3 complication cases comprised two incidences of post-paracentesis hemoperitoneum and one of hemothorax. Both cases of hemoperitoneum had INR > 1.5, were self-limiting, and soon resolved with conservative care, while the hemothorax had normal INR of 1.11 and required chest drain insertion. Of the 853 US-guided pleural and abdominal drainage procedures, there were 98 cases with INR ≥1.50 and/or platelet count <50x10^9/L. The complication rate for this group that previously did not fulfill criteria for drainage was 2.0%(2/98), which is still within acceptable limits in accordance with Society of Interventional Radiology(SIRS) 2019 guidelines. In conclusion, our results demonstrate that US-guided pleural and abdominal drainage procedures can safely be performed with relaxed hemostasis guidelines of INR <2.0 and platelet count >20x10^9/L, with the complication rate within international quality-assurance standards. Thus, we will continue to follow these new guidelines, which are based on international standards and have saved many unnecessary blood-product transfusion procedures. Our findings may provide impetus to the more widespread adoption of these newer guidelines for low bleeding-risk procedures in other HA centres, with the potential of saving a significant amount of HA resources and minimizing patient exposure to transfusion-related risks.
