Endocrine Abstracts

Introduction: Thyroid fine-needle aspiration cytology (TFNA) is a widely used diagnostic method that is generally safe. Aiming to reduce haemorrhage doctors frequently advise patients to withdrawal antithrombotic/anticoagulant (AT/AC) drugs before TFNA. There are no guidelines recommending so and the so called ‘novel anticoagulants’ have been poorly studied in this context. Some patients are likely being exposed to increased thrombotic risk unnecessarily. Evidence is little but increasing indicating no extra risk of haemorrhagic complications and possibly no need of antithrombotic/anticoagulant (AT/AC) drug withdrawal.

Objective: To compare the incidence of haemorrhage in patients with and without AT/AC drugs during FNA in our centre.

Method: Retrospective observational study of the FNAs performed between the 1st of may 2019 and the 31st of december 2021. Records of haemorrhage and drug treatment were made prospectively during FNA. All FNAs were performed by the same operator, using the same technique and needle gauge. In warfine treated patients FNA was performed if INR was 2-3.

Results: We evaluated 491 FNAs, patients average age was 61y.o. The general incidence of haemorrhage was 3.6%. Of the patients with this complication only 2 were taking AT/AC drugs (11%), one had stopped aspirin 3days, the other stopped dabigatran 1week and the rest was off any AT/AC drugs. The total of patients treated with AT/AC drugs was 78 (16%). In this group the incidence of haemorrhage was 2.5%, represents 2 patients both treated with antithrombotic drugs (one aspirin and the other clopidogrel). There were no haemorrhages with enoxaparin nor with any oral anticoagulant. There was no statistically significant difference (SSD) (p 0, 63) in the incidence of haemorrhages in the treated vs untreated group (n=348). There was no SSD (p 0, 30) in the incidence of haemorrhages in the treated group vs the group that stopped therapy 24h to 3days before the procedure (n=16). There was no SSD (p 0, 46) in the incidence of haemorrhages between the group that stopped therapy 24h to 3days before the procedure and the group that stopped therapy 4days to 1month before the procedure (n=13).

Conclusion: There was no significant association of haemorrhage with drug treatment. The incidence of complications was lower in the treated group. There were no complications in patients treated with anticoagulants, haemorrhage occurred in patients taking antithrombotic drugs only (the incidence was lower than in the untreated group). To withdrawal AT/AC drugs before the procedure did not provide a statistically significant decrease in haemorrhagic complications.