The effect of concurrent acetylsalicylic acid on hemorrhagic complications during percutaneous image-guided lung biopsy

Abstract

Background: CT-guided trans-thoracic lung biopsy (CT-TTLB) is efficient and widely used to diagnose pulmonary nodules. After pneumothorax, the second most frequent complication is hemoptysis, which can be life-threatening. These patients often have comorbidities and are on acetylsalicylic-acid (ASA) therapy. The aim of this study was to assess ASA as a risk factor for hemoptysis or severe hemoptysis following CT-TTLB.

Methods: We retrospectively reviewed consecutive patients undergoing CT-TTLB from 2 centers between 01/2018 and 01/2021. Exclusion criteria were nodules with a pleural contact or a contraindication to lung puncture. Clinical and imaging data were recorded such as age, gender, comorbidities, hemoptysis (every blood spit), severe hemoptysis (>200 mL / oxygen need>10L/min / intervention or resuscitation / death), nodule size, puncture depth, emphysema, nodule location, patient position and histology. Lung parenchymal hemorrhage (LPH) was quantified in cm³ on CT after biopsy. Univariate and multivariate analysis were performed with a logistic regression model, without and with propensity match score, to identify variables associated with hemoptysis and severe hemoptysis.

Results: Four-hundred-and-one patients were analyzed, 106 and 295 in the ASA or the control group respectively. In multivariate analysis, ASA use was a risk factor for severe hemoptysis (OR=4.5; 95 %CI[1.3-15.9]) but not for hemoptysis (OR=1.7; 95 %CI[0.5-3.1]), persisting after matching. There was no difference for LPH between the ASA and the control sub-groups (median (IQR)) 5.2cm³ (15.3) vs 3.1cm³ (11.5) p = 0.2).

Conclusions: Treatment with ASA did not increase the risk of all hemoptysis occurrence after CT-TTLB but was a risk factor for severe hemoptysis.

Keywords: Acute Lung Injury; Blood Viscosity; Image-guided biopsy; Solitary pulmonary nodule.