Do anticoagulation medications increase the risk of haematoma in ultrasound‐guided fine needle aspiration of thyroid lesions?

摘要

Background A feared complication of thyroid fine needle aspiration ( FNA ) is bleeding diathesis and haematoma at the biopsy site. Patients are often advised to discontinue antithrombotic/anticoagulant ( AT / AC ) medications prior to the procedure. The aim of this study was to examine the risk of bleeding in patients on AT / AC medications undergoing cervical ultrasound ( US )‐guided FNA . Methods A retrospective chart review of 803 patients who underwent US ‐guided FNA of thyroid nodules over 8?years by a single endocrine surgeon was undertaken. Clinical variables, patient demographics and use of AT / AC medications were collected and analysed. The principle outcome measures included the incidence of procedure‐related haematoma formation. Multivariable logistic regression was used to investigate the possible independent association between post‐ FNA haematoma and anticoagulation, adjusting for age, African American race, body mass index, vascularity and lesion size. Results A total of 1568 lesions were included in 803 patients. The mean age for the patients on AT / AC was 63.0?±?10.4?years and those not on AT / AC was 50.1?±?14.2?years ( P ??0.001). Of those, 148 patients had 336 lesions (21%) biopsied while taking one or more daily AT / AC agent (81 patients: aspirin; 11 patients: Plavix; 17 patients: aspirin and warfarin; 30 patients: aspirin and Plavix; seven patients: rivaroxaban and aspirin; and two patients: ticagrelor and aspirin). Three patients (0.89%) in the AT / AC group compared to six patients (0.49%) not receiving AT / AC medications developed a haematoma ( P ?=?0.41). All complications were treated conservatively and none required intervention. Conclusions US ‐guided FNA of thyroid lesions can be safely performed on patients taking AT / AC including newer agents, without an increase in adverse outcomes or decreased diagnostic rate. Further larger prospective multi‐institutional studies are warranted to further investigate this important finding.