Antiplatelet and anticoagulation use and risk of bleeding from percutaneous dilatational tracheostomy insertion: Systematic review and meta-analysis.

Abstract

Introduction: Antiplatelet and anticoagulation therapies are frequently required in acutely unwell patients and confer an increased propensity for procedural bleeding. During percutaneous tracheostomy insertion, the decision to stop these therapies is left to clinical decision-makers. This meta-analysis summarises the risk of bleeding associated with antiplatelet and anticoagulation therapy during percutaneous tracheostomy insertion.

Method: We conducted a systematic review and meta-analysis of studies which reported intraoperative bleeding during percutaneous tracheostomy while on single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT), as well as therapeutic anticoagulation (TAC). Groups were compared against those with prophylactic or no anticoagulation. Studies were pooled using random effects via the inverse variance method.

Results: Four databases found 22 eligible studies, of which 14 studies presented data for meta-analysis representing 3,485 percutaneous tracheostomy insertion procedures. These included six studies that reported intraoperative bleeding outcome SAPT, six for DAPT and five for TAC. Overall, methodological quality was poor. No significant association was found for SAPT (Odds ratio 1.58; 95% confidence interval 0.72-4.41); P = 0.25; I ² = 81%) and TAC (OR 1.79; 95% CI 0.58-5.56; P = 0.35; I² = 35%). The DAPT group was associated with increased bleeding with an OR of 2.05 (95% CI 1.18-3.56; P = 0.01; I ² = 0%).

Conclusion: Our study supports temporarily withholding DAPT or TAC (if clinically feasible) to minimize bleeding risks associated with percutaneous dilatational tracheostomy.