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Hypo-coagulated patients and ultrasound guided fine-needle aspiration of thyroid nodules: a worry?

Thyroid Ultra Sound guided Fine-Needle Aspiration (USFNA) is the gold standard for thyroid nodules diagnosis. Many patients are under anticoagulation or antiplatelet medication. Haemorrhagic complications of US-FNA are rare. It is not clear if performing thyroid US-FNA in hypocoagulated patients increase risk of complications or if this medication should be stopped before the procedure. Additionally, influence that anticoagulated state may have on number of non-diagnostic cytological results is unknown. It is our purpose to assess haemorrhagic risk and impact on non-diagnostic results of thyroid US-FNA, performed in patients under anticoagulation/antiplatelet therapy. Methods: Retrospective study of 278 thyroid US-FNA performed during 18 months. Patients were divided into two groups according to whether doing or not anticoagulation/antiplatelet medication. None of patients stopped that medication before the procedure, which was made by the same radiologist. In each group was evaluated the prevalence of haemorrhagic and non-haemorrhagic complications and the number of non-diagnostic results. Statistical analysis was performed using SPSS with significance index p<0,05. Results: 278 thyroid US-FNA were analysed. Majority of patients were female (55,5%) with a medium age of 66,8 years. 71,7% of patients were included on Control Group (without medication) and 28,3% on Hypo-coagulated Group (under anticoagulation/antiplatelet medication). This last group comprise 67,5% of patients doing antiplatelet medication, 25,6% of patients undergoing direct oral anticoagulant agents (DOAC) and 6,7% under vitamin K inhibitors. Prevalence of haemorrhagic complications on the Hypocoagulated Group was 1,35% (p=0,11). Non-haemorrhagic complications were reported in 1,96% on control group and