Guidelines for Minimizing Bleeding Risk During Bronchoscopic Procedures.

Adam Barczyk, Anna Andrychiewicz, Małgorzata Czajkowska-Malinowska, Katarzyna Górska, Bartosz Hudzik, Piotr Korczyński, Rafał Krenke, Wojciech Naumnik, Wojciech J Piotrowski, Cezary Piwkowski, Jerzy Soja, Artur Szlubowski, Jerzy Windyga, Joanna Zając, Filip Mejza

Journal: Advances in respiratory medicine 2026;94(4):

PMID: 42496253

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Abstract

This article presents recommendations aimed at reducing the risk of bleeding during bronchoscopy. The document was developed by a working group convened by the Polish Respiratory Society, which included pulmonologists experienced in bronchoscopic procedures, an anesthesiologist, a thoracic surgeon, a cardiologist, a hematologist, a nurse, and methodologists. Clinical questions were formulated according to the PICO (Population, Intervention, Comparison, Outcome) framework, followed by a systematic literature search and critical appraisal of the selected studies. Based on these data, 13 recommendations/good clinical practice points were developed addressing bronchoscopy in patients with thrombocytopenia, abnormal activated partial thromboplastin time or international normalized ratio results, and in those receiving antiplatelet agents, oral anticoagulants, or low-molecular-weight heparin.

Address: Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland.; Department of Endoscopy, University Hospital, Jagiellonian University Medical College, 30-688 Krakow, Poland.; Department of Lung Diseases and Respiratory Failure with the NWM Sub-Unit and the Sleep Breathing Disorders Sub-Unit, Kuyavian-Pomeranian Center of Pulmonology, 85-326 Bydgoszcz, Poland.; Department of Pulmonary Diseases, Internal Medicine, Thoracic Oncology and Transplantology, National Medical Institute, Ministry of the Interior and Administration, 02-507 Warsaw, Poland.; Third Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, 41-800 Zabrze, Poland.; Department of Cardiovascular Disease Prevention, Medical University of Silesia, 41-902 Bytom, Poland.; Department of Internal Medicine, Pulmonary Diseases, and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland.; 1st Department of Lung Diseases, Lung Cancer, and Internal Diseases, Medical University of Bialystok, 15-540 Bialystok, Poland.; Department of Pneumology, Medical University of Lodz, 90-419 Lodz, Poland.; Department of Thoracic Surgery, Poznan University of Medical Sciences, 60-512 Poznan, Poland.; Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, 30-688 Krakow, Poland.; Endoscopy Unit, St. John Paul II Hospital, 31-202 Krakow, Poland.; Bronchoscopy Unit, Klara Jelska's Pulmonary Hospital, 34-500 Zakopane, Poland.; Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland.; Department of Epidemiology and Preventive Medicine, Division of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland.; Department of Epidemiology and Preventive Medicine, Division of Epidemiology, Jagiellonian University Medical College, 31-034 Krakow, Poland.

DOI: 10.3390/arm94040044

MeSH Terms: Humans, Bronchoscopy, Anticoagulants, Practice Guidelines as Topic, Blood Loss, Surgical, Hemorrhage