Safety of Thoracentesis and Tube Thoracostomy in Patients With Uncorrected Coagulopathy: A Systematic Review and Meta-analysis

Chest. 2021 Nov;160(5):1875-1889. doi: 10.1016/j.chest.2021.04.036. Epub 2021 Apr 24.


Background: Thoracentesis and tube thoracostomy are common procedures with bleeding risks, but existing guidelines may be overly conservative. We reviewed the evidence on the safety of thoracentesis and tube thoracostomy in patients with uncorrected coagulopathy.

Research question: Is it safe to perform thoracentesis and tube thoracostomy in patients with uncorrected coagulopathy?

Study design and methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. PubMed and Embase were searched from inception through December 31, 2019. Included studies involved patients with uncorrected coagulopathy because of disease (eg, thrombocytopenia, liver cirrhosis, kidney failure) or drugs (eg, antiplatelets, anticoagulants). Relevant outcomes were major bleeding and mortality.

Results: Eighteen studies (5,134 procedures) were included. Using random-effects meta-analysis, the pooled major bleeding and mortality rate was 0 (95% CI, 0%-1%). No publication bias was found. Excluding six studies that were in abstract form, meta-analysis of the remaining 12 full articles showed that the pooled major bleeding and mortality rate also was 0 (95% CI, 0%-2%). Subgroup analysis performed for patients with uncorrected coagulopathy resulting from disease or drugs showed similar results.

Interpretation: Among patients with uncorrected coagulopathy who underwent thoracentesis or tube thoracostomy, major bleeding and mortality complications were uncommon. Our results suggest that in appropriately selected patients, thoracentesis or tube thoracostomy can be performed safely.

Trial registry: PROSPERO; No.: CRD42020152226; URL:

Keywords: bleeding complications; pleural effusion; pneumothorax; thoracentesis; thoracostomy.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Blood Coagulation Disorders* / complications
  • Blood Coagulation Disorders* / etiology
  • Hemorrhage / etiology
  • Hemorrhage / prevention & control*
  • Humans
  • Pleural Diseases / complications
  • Pleural Diseases / surgery
  • Risk Adjustment / methods*
  • Thoracentesis* / adverse effects
  • Thoracentesis* / methods
  • Thoracostomy* / adverse effects
  • Thoracostomy* / methods