Safety of Transesophageal Echocardiography in Patients with Thrombocytopenia

Danai Kitkungvan; Divya Kalluru; Abhishek Lunagariya; Liza Sanchez; Syed Wamique Yusuf; Saamir Hassan; Nicolas Palaskas; Elie Mouhayar; Jose Banchs

doi:10.1016/j.echo.2019.04.421

Safety of Transesophageal Echocardiography in Patients with Thrombocytopenia

J Am Soc Echocardiogr. 2019 Aug;32(8):1010-1015. doi: 10.1016/j.echo.2019.04.421. Epub 2019 Jun 22.

Authors

Danai Kitkungvan¹, Divya Kalluru², Abhishek Lunagariya², Liza Sanchez², Syed Wamique Yusuf², Saamir Hassan², Nicolas Palaskas², Elie Mouhayar², Jose Banchs³

Affiliations

¹ Division of Cardiovascular Medicine, University of Texas Health and Science Center at Houston, Houston, Texas.
² Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas.
³ Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: jbanchs@mdanderson.org.

PMID: 31239084
DOI: 10.1016/j.echo.2019.04.421

Abstract

Background: According to current literature and guidelines, thrombocytopenia is considered a relative contraindication for performing transesophageal echocardiogram (TEE). In cancer patients, thrombocytopenia is frequently present. No prior studies have assessed the safety and complications of TEE in a thrombocytopenic population.

Methods: From January 2002 to December 2017, all patients who underwent TEE at MD Anderson Cancer Center in the nonoperative setting were included in the study. Patient characteristics, laboratory data, indications, and complications of TEE were obtained from medical records. Thrombocytopenia was defined as platelet count <100,000/μL prior to procedure. In this retrospective study, medical records were reviewed up to 30 days after procedure to search for possible complications related to TEE.

Results: During the study period, 2,345 TEE studies were performed. The mean age was 58.2 ± 15.3 years and 58.8% of patients were male. Thrombocytopenia was found in 814 patients (34.7%). More thrombocytopenic patients had hematologic malignancy, when compared with patients with normal platelet level (79.7% vs 30.2%; P < .001). The most common indication for TEE study was to evaluate for suspected endocarditis (48.0%) and was found more frequently in thrombocytopenic patients compared with those with normal platelet count (69.5% vs 36.5%; P < .001). Overall, 10 patients (0.4%) had complications related to TEE: eight minor oropharyngeal bleeding that did not require transfusion, one transient atrial fibrillation, and one esophageal perforation. There was no major bleeding, respiratory failure, or death related to TEE examination during the study period. Minor oropharyngeal bleeding was the only complication seen in thrombocytopenic patients (seven patients, 0.3%).

Conclusions: Thrombocytopenia is common in cancer patients undergoing TEE. TEE-related complications are minimal in patients with both normal or low platelet count. With appropriate patient preparation and careful probe manipulation, TEE can be safely performed in thrombocytopenic patients.

Keywords: Procedural safety; TEE complications; Thrombocytopenia; Transesophageal echocardiogram (TEE).

MeSH terms

Cardiovascular Diseases / diagnostic imaging*
Cardiovascular Diseases / etiology*
Echocardiography, Transesophageal*
Female
Humans
Male
Middle Aged
Neoplasms / complications*
Retrospective Studies
Thrombocytopenia / etiology*