Abstract
Objective
This systematic review and meta-analysis aimed to evaluate the proportion of major bleeding events in patients using clopidogrel who underwent thoracentesis or other pleural procedures. As clopidogrel is a widely used antiplatelet agent, its continuation during invasive procedures raises safety concerns.
Methods
A comprehensive search was conducted in PubMed, Cochrane Library and Embase from inception to July 2025, following PRISMA guidelines. Eligible studies included observational or randomised trials that reported major bleeding outcomes in patients who continued clopidogrel during thoracentesis, small-bore chest tube insertion, or pleural catheter placement. Data extracted included demographic variables, procedural details and bleeding event rates. Study quality was assessed using the Newcastle-Ottawa Scale. The pooled proportion of bleeding events was calculated using a random-effects model. A subgroup analysis was conducted for studies specific to thoracentesis. Heterogeneity was assessed with the I2 statistic. Sensitivity analyses and meta-regression (based on publication year and sample size) were performed to evaluate result stability and potential effect modifiers.
Results
Twelve studies including 392 patients met the inclusion criteria. The pooled bleeding event rate was 0.0004 (95% CI: 0.0000–0.0102), and for thoracentesis-only studies it was 0.0012 (95% CI: 0.0000–0.0148). Heterogeneity was negligible (I2 = 0%). Leave-one-out analysis confirmed robustness, and no significant publication bias was detected. Meta-regression did not identify any significant moderators.
Conclusion
The findings suggest that clopidogrel continuation during thoracentesis is associated with a very low risk of major bleeding. Routine discontinuation may not be necessary, although additional high-quality studies are warranted.