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• W4387247999 abstract "SESSION TITLE: Procedures Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Bleeding is a known complication with any bronchoscopy. As the population continues to age and lung cancer screening becomes more utilized, many patients will present with lung nodules who are on anti-platelet agents. The decision to perform bronchoscopy while on these medications is challenging and needs to be individualized on a case-by-case basis. We present a case of a patient who was unable to stop her ticagrelor prior to EBUS-TBNA and EUS-B-FNA. CASE PRESENTATION: The patient is a 63-year-old female with a history of COPD on 3L and coronary artery disease on ticagrelor. In October 2021 she had a CT chest for lung cancer screening that showed a left lower lobe nodule measuring 16 mm. A follow up PET scan showed FDG avidity in the left lower lobe lesion. Given her pre-existing COPD, a biopsy was not performed. She was treated as a presumed NSCLC with SBRT. A follow-up CT scan in November 2022 showed several new sub-centimeter nodules and several new enlarged lymph nodes suspicious for metastatic disease. She had a restaging PET scan that showed FDG avid medial hilar and perihilar lymphadenopathy. Given her significant history of coronary artery disease, the patient was not able to stop her ticagrelor for the procedure. She underwent EBUS-TBNA of level 7 and EUS-B-FNA of level 8 which were positive for small cell carcinoma. The procedure was uncomplicated with no bleeding noted after samples were obtained. DISCUSSION: Few studies have evaluated the safety of patients undergoing bronchoscopy while on clopidogrel, but none while on ticagrelor. Both clopidogrel and ticagrelor inhibit ADP-induced platelet aggregation. Unlike clopidogrel, ticagrelor reversibly inhibits it. Current guidelines recommend holding anti-platelets for at least 5 days prior to bronchoscopy, and at least 24 hours after the procedure. Clopidogrel takes 3 days to have 40% of platelet function return, where ticagrelor will have 57% of platelet function at 24 hours. The decision to perform procedures while patients are on anti-platelets is dependent on the bleeding risk of the different bronchoscopic procedures. Relative bleeding risk is low for EBUS-TBNA, BAL, airway exams, and suctioning, but it is high for transbronchial biopsies or rigid bronchoscopies. Meena et al was a retrospective study of patients undergoing EBUS-TBNA and EUS-FNA and found 37 patients who were taking clopidogrel at the time of biopsy. They found no clinically significant bleeding complications. CONCLUSIONS: Holding anticoagulation is not always a possibility in certain individuals, and delaying bronchoscopy until you are able to stop antiplatelets may cause a significant delay in diagnosis and appropriate treatment. Factors that influence the decision to continue with the procedure includes the invasiveness of the procedure, the indication for the anti-platelet medication, and the specific anti-platelet medication. REFERENCE #1: Meena N, Abouzgheib W, Patolia S, Rosenheck J, Boujaoude Z, Bartter T. EBUS-TBNA and EUS-FNA: Risk Assessment for Patients Receiving Clopidogrel. J Bronchology Interv Pulmonol. 2016 Oct;23(4):303-307. doi: 10.1097/LBR.0000000000000312. PMID: 27479011. REFERENCE #2: Youness HA, Keddissi J, Berim I, Awab A. Management of oral antiplatelet agents and anticoagulation therapy before bronchoscopy. J Thorac Dis. 2017 Sep;9(Suppl 10):S1022-S1033. doi: 10.21037/jtd.2017.05.45. PMID: 29214062; PMCID: PMC5696555. REFERENCE #3: Abuqayyas S, Raju S, Bartholomew JR, Abu Hweij R, Mehta AC. Management of antithrombotic agents in patients undergoing flexible bronchoscopy. Eur Respir Rev. 2017 Jul 19;26(145):170001. doi: 10.1183/16000617.0001-2017. PMID: 28724561; PMCID: PMC9488780. DISCLOSURES: No relevant relationships by Katie Alsheimer No relevant relationships by Jonathan Burgei No relevant relationships by Boyd Hehn" @default.
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• W4387247999 date "2023-10-01" @default.
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• W4387247999 title "EBUS-TBNA AND EUS-B-FNA IN A PATIENT ON TICAGRELOR" @default.
• W4387247999 doi "https://doi.org/10.1016/j.chest.2023.07.3453" @default.
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