Chest
Volume 115, Issue 2, February 1999, Pages 397-402
Journal home page for Chest

Clinical Investigations
LUNG TRANSPLANTATION
The Higher Risk of Bleeding in Lung Transplant Recipients From Bronchoscopy Is Independent of Traditional Bleeding Risks: Results of a Prospective Cohort Study

https://doi.org/10.1378/chest.115.2.397Get rights and content

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.

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 medications, 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 medication 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.

Section snippets

Materials and Methods

This prospective cohort study of patients undergoing fiberoptic bronchoscopy was conducted at the Johns Hopkins Medical Institutions between July 1, 1996, and June 30, 1997. The overall goals of the study, called the Bronchoscopy Quality Improvement project (BRONCHQI), were to identify predictors of outcomes of fiberoptic bronchoscopy and to improve rates of adverse events, diagnostic success, patient comfort, and patient satisfaction. Data were collected from physicians, nurses, patients, and

Results

Between July 1, 1996, and June 30, 1997, 720 FOBs were performed. Data were reported by physicians in 697 cases (96.8%). During the period when the patient questionnaire was used, 608 FOBs were performed. Of these, 521 (85.7%) were in eligible patients, and, of the eligibles, 451 patients (86.6%) completed the forms before and after the procedure.

Discussion

This study demonstrates that lung transplant patients are more likely to bleed than are other types of patients during and after FOB. The propensity to bleed was not explained by bleeding parameters (PT, aPTT, platelet counts), aspirin use, or the performance of transbronchial lung biopsy. Bleeding is a potentially serious outcome of FOB, which can result in respiratory failure or death.8 This greater risk of bleeding should be considered in weighing the risks and benefits of the procedure in

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Supported by a grant from the Johns Hopkins Bayview Physicians Association. Dr. Diette was supported by NHLBI (National Heart, Lung and Blood Institute)training grant number 2 T32 HL07534.

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