Managing Endobronchial Biopsy Risks in Patients on Clopidogrel and Aspirin

Clinicians face a significant challenge performing endobronchial biopsy in patients receiving antiplatelet therapy with clopidogrel and aspirin, as the antiplatelet effect substantially heightens bleeding risks.

Bleeding complications during an endobronchial biopsy in this population demand meticulous pre-procedural assessment and planning. Individual hemostatic profiles must be evaluated, and procedural teams should prepare for rapid hemostasis interventions, equipment readiness and post-procedural monitoring to ensure biopsy safety.

Current recommendations advise weighing the thrombotic risk of interrupting antiplatelet therapy against potential hemorrhagic complications. Earlier findings suggest that collaborating with cardiology to tailor the timing of clopidogrel and aspirin interruption—and, when feasible, resuming therapy promptly post-biopsy—can mitigate both bleeding and cardiovascular risks.

Recent work on the phenotype of pulmonary arterial hypertension with cardiopulmonary comorbidities underscores how PAH patients often carry overlapping cardiac and pulmonary vulnerabilities that magnify procedural risk. In these cases, a multidisciplinary approach involving pulmonologists, cardiologists and anesthesiologists is essential to customize sedation, hemodynamic support and peri-procedural monitoring.

Translating these insights into practice involves dynamic decision-making: determining whether to delay biopsy for antiplatelet washout, adopting minimally invasive sampling techniques or employing adjunctive hemostatic agents. What remains unclear is the universal standard for adjusting antiplatelet therapy while minimizing procedural risk, emphasizing the importance of continued research and inter-specialty collaboration to refine biopsy procedural frameworks and improve patient outcomes.

Key Takeaways:

• The risk of bleeding is a critical concern during biopsies in patients on antiplatelet therapy, necessitating comprehensive pre-procedural strategies.
• Consulting with cardiology is essential to balance risks when adjusting antiplatelet medications in anticipation of biopsy procedures.
• Unique clinical challenges persist among patients with both pulmonary arterial hypertension and cardiopulmonary comorbidities, requiring a personalized management approach.
• The evolution of guidelines in this area is ongoing, highlighting the need for continued research and collaborative practice improvements.