Abstract:

Background US-guided tube thoracostomy (US-TT) is widely employed for pleural effusion management, however bleeding complications remain a clinical concern.
Objective To identify risk factors for bleeding during US-TT, focusing on doctor experience, coagulation status, malignancy, and anticoagulant/antiplatelet medication use.
Methods In this retrospective cohort study, we analyzed 4,073 patients undergoing US-TT between January 2019 and January 2024. Using univariate analysis and multivariate binary logistic regression, we evaluated associations between post-procedural bleeding and the following factors: coagulation parameters (PLT, INR, APTT), inflammatory markers, use of anticoagulant/antiplatelet medications, malignancy status, and doctor experience (junior vs. senior). Demographic and clinical data were extracted from electronic medical records.
Results Bleeding occurred in 24 patients (0.6%). Univariate analysis identified procedure performance by junior physicians and presence of malignancy as significant risk factors (P < 0.05). No significant associations were found with coagulation parameters, inflammatory markers, or medication use. Factors with P < 0.1 (junior doctor, malignancy, INR > 2.0, elevated leukocyte count) were included in multivariate analysis. This confirmed junior doctor status (OR, 3.333; P = 0.033) and malignancy (OR, 3.960; P = 0.016) as independent predictors of bleeding.
Conclusions US-TT carries a low overall bleeding risk (0.6%). In this study, bleeding was associated with malignancy and less experienced doctors, but not significantly with routine coagulation indices. A trend toward increased risk with INR > 2.0 warrants caution.

Key words: Tube thoracostomy; Bleeding; Experience; Ultrasound; Malignancy