ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P757 | DOI: 10.1530/endoabs.63.P757

Hypo-coagulated patients and ultrasound guided fine-needle aspiration of thyroid nodules: a worry?

Catarina Ivo, David Veríssimo, Vitória Duarte, João Silva, Luís Lopes, Dolores Passos, João Jácome de Castro & Mafalda Marcelino


Endocrinology Department – Portuguese Armed Forces Hospital, Lisbon, Portugal.


Introduction: Ultrasound guided Fine-Needle Aspiration (USFNA) of Thyroid is the gold standard for diagnosis of thyroid nodules. Nowadays, many patients are under anticoagulation and antiplatelet medication. Some of the rare complications of USFNA are haemorrhage therefore it’s not clear if performing thyroid USFNA in hypo-coagulated patients increase that risk of complications or if this medication should be stopped before the procedure. Additionally the influence that the hypo-coagulated state may have on the number of non-diagnostic cytological results is unknown. It is our purpose to assess the haemorrhagic risk and impact on non-diagnostic results of thyroid USFNA performed in patients under anticoagulation/antiplatelet therapy.

Methods: Retrospective study of 223 patients that performed 278 thyroid USFNA between January of 2017 and July of 2018. Patients were divided into two groups according to whether doing or not anticoagulation/antiplatelet medication (including novel oral anticoagulant agents (NOAC)). None of patients stopped anticoagulation/antiplatelet medication before the procedure. In each group was evaluated the prevalence of haemorrhagic and non-haemorrhagic complications and the number of non-diagnostic results. All statistical analysis, was performed by using SPSS with significance index P<0.05.

Results: A total of 278 thyroid USFNA were analysed. The majority of the patients were female (55.5%) with a medium of age of 66.8 years. 71.7% of the patients were included on Control Group (without medication) and 28.3% on the Hypo-coagulated Group (under anticoagulation/antiplatelet medication). This last group comprise 67.5% of patients doing antiplatelet medication (20% under aspirin (AAS), 1.35% under AAS and clopidogrel, 41.9% under clopidogrel, 2.7% with triflusal and 1.35% under ticlopidine), 25.6% of patients undergoing NOAC (14.9% under rivaroxaban, 9.5% under dabigatran and 1.35% under edoxaban) and 6.7% of patients on vitamin K inhibitors (warfarin). Comparing with Control Group (0%), the prevalence of haemorrhagic complications on the Hypo-coagulated Group was 1.35% (P=0.11). Non-haemorrhagic complications such as local pain and discomfort, were reported in 1.96% on control group and in 2.7% on hypo-coagulated group (P=0.71). Relatively to the number of non-diagnostic cytological results, was found in 2.5% of the total US-FNA performed, 1.47% on the control group and 5.4% on hypo-coagulated group (P=0.07).

Conclusion: Haemorrhagic complications after thyroid USFNA are minimal and usually without severity. Taking into account the results obtained and the existing bibliography, it is concluded that the haemorrhagic risk of hypo-coagulated patients is not significantly increased. It seems wise to recommend the non-cessation of anticoagulation/antiplatelet medication prior to the thyroid USFNA.

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