The higher risk of bleeding in lung transplant recipients from bronchoscopy is independent of traditional bleeding risks: Results of a prospective cohort study

Research output: Contribution to journalArticle

Abstract

Study objective: To determine whether recipients of lung transplants have a higher risk of bleeding from fiberoptic bronchoscopy (FOB) than other patients who undergo the procedure. Design: Prospective cohort study. Setting: Bronchoscopy services of Johns Hopkins Hospital, a tertiary referral center and Johns Hopkins Bayview Medical Center, a community hospital. Patients: All adult patients (18 years) who underwent FOB between July 1, 1996 and June 30, 1997 by the full-time pulmonary medicine staff were included. A total of 720 procedures were performed, including 38 in lung transplant recipients. Measurements: Bleeding was assessed by reviewing physician reports of bloody drainage after the procedure and whether the procedure was terminated early for bleeding. Patient reports of hemoptysis were assessed using questionnaires administered pre- and post-FOB. Predictor variables included patient demographics, bleeding parameters (platelets, prothrombin time, and activated partial thromboplastin time), immunosuppressive meditations, aspirin use, use of transbronchial biopsy, and the time length of the procedure. Results: Lung transplant recipients were significantly more likely to have used aspirin prior to FOB (18.4 vs 7.2%, p <0.05) and to undergo transbronchial biopsy (64.9 vs 26.8%, p <0.001). Lung transplant patients were more likely to have new or worsened hemoptysis (53.8 vs 24.6%, p <0.001), to have > 25 mL of blood loss (44.5 vs 17.5%, p <0.001) and to have the procedure terminated early for bleeding (5.4 vs 1.0%, p <0.05). In multivariate analysis, predictors of new or worsened hemoptysis included lung transplant, longer procedure time, and older patient age. Independent predictors of greater blood loss included lung transplant, performance of transbronchial biopsy, longer procedure time, and older patient age. Conclusions: Lung transplant recipients are at higher risk of bleeding from bronchoscopy than are other patients. This propensity to bleed is independent of coagulation parameters, platelet count, immunosuppressive meditation use, aspirin use, or performance of transbronchial biopsy. The higher risk of bleeding should be considered when assessing the risks and benefits of bronchoscopy in lung transplant recipients.

Original languageEnglish (US)
Pages (from-to)397-402
Number of pages6
JournalChest
Volume115
Issue number2
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

Bronchoscopy
Cohort Studies
Prospective Studies
Hemorrhage
Lung
Aspirin
Meditation
Hemoptysis
Immunosuppressive Agents
Biopsy
Transplants
Pulmonary Medicine
Partial Thromboplastin Time
Transplant Recipients
Prothrombin Time
Community Hospital
Platelet Count
Tertiary Care Centers
Drainage
Blood Platelets

Keywords

  • Bleeding
  • Fiberoptic bronchoscopy
  • Lung transplantation
  • Quality of care
  • Transbronchial biopsy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

@article{249ba4bc4237421eac47e58f4d76e737,
title = "The higher risk of bleeding in lung transplant recipients from bronchoscopy is independent of traditional bleeding risks: Results of a prospective cohort study",
abstract = "Study objective: To determine whether recipients of lung transplants have a higher risk of bleeding from fiberoptic bronchoscopy (FOB) than other patients who undergo the procedure. Design: Prospective cohort study. Setting: Bronchoscopy services of Johns Hopkins Hospital, a tertiary referral center and Johns Hopkins Bayview Medical Center, a community hospital. Patients: All adult patients (18 years) who underwent FOB between July 1, 1996 and June 30, 1997 by the full-time pulmonary medicine staff were included. A total of 720 procedures were performed, including 38 in lung transplant recipients. Measurements: Bleeding was assessed by reviewing physician reports of bloody drainage after the procedure and whether the procedure was terminated early for bleeding. Patient reports of hemoptysis were assessed using questionnaires administered pre- and post-FOB. Predictor variables included patient demographics, bleeding parameters (platelets, prothrombin time, and activated partial thromboplastin time), immunosuppressive meditations, aspirin use, use of transbronchial biopsy, and the time length of the procedure. Results: Lung transplant recipients were significantly more likely to have used aspirin prior to FOB (18.4 vs 7.2{\%}, p <0.05) and to undergo transbronchial biopsy (64.9 vs 26.8{\%}, p <0.001). Lung transplant patients were more likely to have new or worsened hemoptysis (53.8 vs 24.6{\%}, p <0.001), to have > 25 mL of blood loss (44.5 vs 17.5{\%}, p <0.001) and to have the procedure terminated early for bleeding (5.4 vs 1.0{\%}, p <0.05). In multivariate analysis, predictors of new or worsened hemoptysis included lung transplant, longer procedure time, and older patient age. Independent predictors of greater blood loss included lung transplant, performance of transbronchial biopsy, longer procedure time, and older patient age. Conclusions: Lung transplant recipients are at higher risk of bleeding from bronchoscopy than are other patients. This propensity to bleed is independent of coagulation parameters, platelet count, immunosuppressive meditation use, aspirin use, or performance of transbronchial biopsy. The higher risk of bleeding should be considered when assessing the risks and benefits of bronchoscopy in lung transplant recipients.",
keywords = "Bleeding, Fiberoptic bronchoscopy, Lung transplantation, Quality of care, Transbronchial biopsy",
author = "Diette, {Gregory B} and Wiener, {Charles M} and Peter White",
year = "1999",
doi = "10.1378/chest.115.2.397",
language = "English (US)",
volume = "115",
pages = "397--402",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "2",

}

TY - JOUR

T1 - The higher risk of bleeding in lung transplant recipients from bronchoscopy is independent of traditional bleeding risks

T2 - Results of a prospective cohort study

AU - Diette, Gregory B

AU - Wiener, Charles M

AU - White, Peter

PY - 1999

Y1 - 1999

N2 - Study objective: To determine whether recipients of lung transplants have a higher risk of bleeding from fiberoptic bronchoscopy (FOB) than other patients who undergo the procedure. Design: Prospective cohort study. Setting: Bronchoscopy services of Johns Hopkins Hospital, a tertiary referral center and Johns Hopkins Bayview Medical Center, a community hospital. Patients: All adult patients (18 years) who underwent FOB between July 1, 1996 and June 30, 1997 by the full-time pulmonary medicine staff were included. A total of 720 procedures were performed, including 38 in lung transplant recipients. Measurements: Bleeding was assessed by reviewing physician reports of bloody drainage after the procedure and whether the procedure was terminated early for bleeding. Patient reports of hemoptysis were assessed using questionnaires administered pre- and post-FOB. Predictor variables included patient demographics, bleeding parameters (platelets, prothrombin time, and activated partial thromboplastin time), immunosuppressive meditations, aspirin use, use of transbronchial biopsy, and the time length of the procedure. Results: Lung transplant recipients were significantly more likely to have used aspirin prior to FOB (18.4 vs 7.2%, p <0.05) and to undergo transbronchial biopsy (64.9 vs 26.8%, p <0.001). Lung transplant patients were more likely to have new or worsened hemoptysis (53.8 vs 24.6%, p <0.001), to have > 25 mL of blood loss (44.5 vs 17.5%, p <0.001) and to have the procedure terminated early for bleeding (5.4 vs 1.0%, p <0.05). In multivariate analysis, predictors of new or worsened hemoptysis included lung transplant, longer procedure time, and older patient age. Independent predictors of greater blood loss included lung transplant, performance of transbronchial biopsy, longer procedure time, and older patient age. Conclusions: Lung transplant recipients are at higher risk of bleeding from bronchoscopy than are other patients. This propensity to bleed is independent of coagulation parameters, platelet count, immunosuppressive meditation use, aspirin use, or performance of transbronchial biopsy. The higher risk of bleeding should be considered when assessing the risks and benefits of bronchoscopy in lung transplant recipients.

AB - Study objective: To determine whether recipients of lung transplants have a higher risk of bleeding from fiberoptic bronchoscopy (FOB) than other patients who undergo the procedure. Design: Prospective cohort study. Setting: Bronchoscopy services of Johns Hopkins Hospital, a tertiary referral center and Johns Hopkins Bayview Medical Center, a community hospital. Patients: All adult patients (18 years) who underwent FOB between July 1, 1996 and June 30, 1997 by the full-time pulmonary medicine staff were included. A total of 720 procedures were performed, including 38 in lung transplant recipients. Measurements: Bleeding was assessed by reviewing physician reports of bloody drainage after the procedure and whether the procedure was terminated early for bleeding. Patient reports of hemoptysis were assessed using questionnaires administered pre- and post-FOB. Predictor variables included patient demographics, bleeding parameters (platelets, prothrombin time, and activated partial thromboplastin time), immunosuppressive meditations, aspirin use, use of transbronchial biopsy, and the time length of the procedure. Results: Lung transplant recipients were significantly more likely to have used aspirin prior to FOB (18.4 vs 7.2%, p <0.05) and to undergo transbronchial biopsy (64.9 vs 26.8%, p <0.001). Lung transplant patients were more likely to have new or worsened hemoptysis (53.8 vs 24.6%, p <0.001), to have > 25 mL of blood loss (44.5 vs 17.5%, p <0.001) and to have the procedure terminated early for bleeding (5.4 vs 1.0%, p <0.05). In multivariate analysis, predictors of new or worsened hemoptysis included lung transplant, longer procedure time, and older patient age. Independent predictors of greater blood loss included lung transplant, performance of transbronchial biopsy, longer procedure time, and older patient age. Conclusions: Lung transplant recipients are at higher risk of bleeding from bronchoscopy than are other patients. This propensity to bleed is independent of coagulation parameters, platelet count, immunosuppressive meditation use, aspirin use, or performance of transbronchial biopsy. The higher risk of bleeding should be considered when assessing the risks and benefits of bronchoscopy in lung transplant recipients.

KW - Bleeding

KW - Fiberoptic bronchoscopy

KW - Lung transplantation

KW - Quality of care

KW - Transbronchial biopsy

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