Bronchoscopic Lung Volume Reduction in Patients on Chronic Anticoagulation: Insight from the National Inpatient Sample Database.

Abstract

Bronchoscopic lung volume reduction (BLVR) is a minimally invasive option for advanced COPD, but carries bleeding risk. A significant proportion of COPD patients requiring BLVR are on chronic anticoagulation, yet data on procedural safety in this population remains scarce. We conducted a retrospective study using the National Inpatient Sample (NIS) database (2016-2023). Adult BLVR patients were stratified by chronic anticoagulation status. The primary outcomes were hemothorax and pulmonary bleeding. Secondary outcomes included any bleeding (gastrointestinal, pulmonary, intracranial, retroperitoneal, hematuria, hemothorax, or acute blood loss anemia), pneumothorax, in-hospital mortality, major adverse cardiac events (MACE), and prolonged hospitalization (≥7 days). Multivariable logistic regression yielded adjusted odds ratios (aORs) controlling demographics, comorbidities, and hospital characteristics. Of 16,340 weighted BLVR hospitalizations, 1,275 (7.8%) involved anticoagulated patients. Anticoagulated patients were older (68.6 vs. 65.7 years) and more frequently male (70.6% vs. 58.5%), with a higher burden of cardiovascular comorbidities. Hemothorax and pulmonary bleeding occurred in 2.7% and 7.1% of anticoagulated patients versus 1.1% and 4.7% of non-anticoagulated patients, respectively. Any bleeding occurred in 14.1% of anticoagulated versus 10.8% of non-anticoagulated patients. These differences were not statistically significant, and chronic anticoagulation was not independently associated with any increased bleeding on multivariable analysis. No significant differences were observed in mortality (aOR 0.88), pneumothorax (aOR 0.72), MACE (aOR 1.13), or prolonged hospitalization (aOR 1.09). Chronic anticoagulation was not independently associated with adverse outcomes following BLVR, suggesting comparable short-term outcomes in this population. Prospective studies examining the timing and types of anticoagulation in BLVR are warranted.