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Bleeding events in patients using clopidogrel undergoing thoracentesis: a systematic review and meta-analysis Cover

Figures & Tables

Figure 1.

PRISMA 2020 flow diagram of the study selection process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
PRISMA 2020 flow diagram of the study selection process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2.

Forest plot showing the pooled proportion of bleeding events across all included studies. CI, confidence interval.
Forest plot showing the pooled proportion of bleeding events across all included studies. CI, confidence interval.

Figure 3.

Forest plot showing the pooled proportion of bleeding events in the thoracentesis-only subgroup. CI, confidence interval.
Forest plot showing the pooled proportion of bleeding events in the thoracentesis-only subgroup. CI, confidence interval.

Figure 4.

Leave-one-out sensitivity analysis for the proportion of bleeding events with Freeman-Tukey Double Arcsine transformation applied for zero events. CI, confidence interval.
Leave-one-out sensitivity analysis for the proportion of bleeding events with Freeman-Tukey Double Arcsine transformation applied for zero events. CI, confidence interval.

Figure 5.

Funnel plot for the proportion of bleeding events with Freeman-Tukey Double Arcsine transformation applied for zero events.
Funnel plot for the proportion of bleeding events with Freeman-Tukey Double Arcsine transformation applied for zero events.

Figure 6.

Meta-regression for total sample size (top) and year of publication (bottom) versus effect size for the proportion of bleeding events in the included studies.
Meta-regression for total sample size (top) and year of publication (bottom) versus effect size for the proportion of bleeding events in the included studies.

The NOS for assessing the quality of studies in meta-analyses_

StudiesSelectionComparabilityOutcomeTotal score
Author, yearSelection of casesSelection of controlsAscertainment of exposureOutcome not present at the startComparability of cases and controlsAssessment of outcomeFollow-up durationFollow-up %
Mahmood et al. (15)111100116
Perl et al. (5)111001116
Irugulapati et al. (8)*101001115
Parks et al. (24)*101001115
Salguero et al. (23)*101001115
Sisniega et al. (22)*111101117
Abouzgheib et al. (21)101101116
Zalt et al. (20)101101116
Dammert et al. (19)101101116
Puchalski 2013111010116
Patel et al. (4)101001115
Aljundi et al. (16)111021118

Baseline characteristics of included studies_

StudyDesignMean ageParticipants/proceduresMale (%)USG%Concurrent aspirin (%)Renal disease (%)Procedure typeDrug studied
Mahmood et al. (15)Prospective70.2 ± 13.32521 (84)10022 (88)3 (12)TC + SBCTClopidogrel
Perl et al. (5)Retrospective77.5 ± 118853 (60)2541 (46)26 (29.5)TCClopidogrel
Irugulapati et al. (8)*RetrospectiveN/A7N/AN/AN/A5 (71.4)TCClopidogrel
Parks et al. (24)*Retrospective65 (41–86)145 (35.6)N/AN/AN/ATCClopidogrel
Salguero et al. (23)*RetrospectiveN/A22N/A10020 (91)N/ATCClopidogrel + Ticagrelor
Sisniega et al. (22)*RetrospectiveN/A5N/AN/A2 (40)N/AIPCClopidogrel + Prasugrel
Abouzgheib et al. (21)Retrospective73.1248 (44.4)10013 (72.2)N/ASBCTClopidogrel
Zalt et al. (20)Prospective75.5 (41–96)459 (30)100N/AN/ATCClopidogrel
Dammert et al. (19)Retrospective71 ± 104321 (70)10027 (91)4 (15)SBCTClopidogrel
Puchalski et al. (18)ProspectiveN/A18N/A100N/AN/ATCClopidogrel
Patel et al. (17)RetrospectiveN/A72N/A10058 (80)N/ATCClopidogrel + Ticagrelor
Aljundi et al. (16)RetrospectiveN/A32N/AN/AN/AN/ATCClopidogrel + Ticagrelor + Prasugrel
DOI: https://doi.org/10.2478/pneum-2025-0017 | Journal eISSN: 2247-059X | Journal ISSN: 2067-2993
Language: English
Page range: 112 - 121
Published on: Aug 11, 2025
In partnership with: Paradigm Publishing Services
Publication frequency: Volume open

© 2025 Fernando Antonio Falcão Paixão Neto, João Martins da Fonseca, Ricardo Gaspar Loureiro Filho, Ana Luisa Soares Chiaretti, Alan Gualberto de Souza de Freitas de Pinho, Lucca Reis Borba, Sarah Fernandez Coutinho de Carvalho, Marília Chadud de Pádua Resende, Pedro Fernandes Abbade, Gabriella Joanna Gomes Estrela de Souza, Manuel Lessa Ribeiro Neto, published by Romanian Society of Pneumology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.