{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T04:45:25Z","timestamp":1782621925114,"version":"3.54.5"},"reference-count":34,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Percutaneous dilatational tracheostomy (PDT) is increasingly performed without interrupting therapeutic anticoagulation in critically ill patients with extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (VADs). However, the safety of PDT performed under ongoing therapeutic anticoagulation, particularly regarding periprocedural bleeding risk, remains uncertain. This study compared periprocedural bleeding complications between patients undergoing PDT under therapeutic and prophylactic anticoagulation. Methods: This observational cohort study in a cardiovascular ICU included all patients who underwent PDT between 2016 and 2024. The cohort comprised critically ill patients receiving uninterrupted therapeutic anticoagulation for ECMO, VAD, MVs (mechanical heart valves), and arrhythmia, as well as patients receiving low-dose anticoagulation for venous thromboprophylaxis. The primary endpoint was any severe procedure-related or late bleeding complication, while secondary endpoints included all minor procedure-related or late bleeding complications. Results: The cohort included 174 patients of whom 84 (48.3%) underwent PDT receiving uninterrupted therapeutic anticoagulation for ECMO, VAD, MVs, or arrhythmia. None experienced severe procedure-related bleeding. The incidence of major and minor bleeding complications did not differ between patients receiving uninterrupted therapeutic anticoagulation and those undergoing PDT under low-dose prophylactic anticoagulation. Other bleeding complications were also rare and comparable between the two groups. Conclusions: In this cohort, the incidence of severe and minor bleeding was low among patients undergoing PDT under uninterrupted therapeutic anticoagulation for ECMO, VAD, MVs, or arrhythmia and did not differ from that in patients receiving low-dose anticoagulation for venous thromboprophylaxis. BMI, but not anticoagulation intensity, was independently associated with post-PDT bleeding.<\/jats:p>","DOI":"10.3390\/jcm15134877","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:09:17Z","timestamp":1782270557000},"page":"4877","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety of Percutaneous Dilatational Tracheostomy Under Uninterrupted Therapeutic Anticoagulation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1135-6921","authenticated-orcid":false,"given":"Bernhard","family":"Zapletal","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3969-7792","authenticated-orcid":false,"given":"Marcus J.","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria"},{"name":"Department of Anaesthesiology, Rescue- and Pain Medicine, Cantonal Hospital St. Gallen, HOCH Health Ostschweiz, 9007 St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4926-0957","authenticated-orcid":false,"given":"Michael J.","family":"Brenner","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Severin","family":"Laengle","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Aortic Surgery, Medical University Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edda M.","family":"Tschernko","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/MCP.0000000000000928","article-title":"Percutaneous Tracheostomy in the ICU: A Review of the Literature and Recent Updates","volume":"29","author":"Romem","year":"2023","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1097\/01.CCM.0000134835.05161.B6","article-title":"A Prospective, Randomized, Study Comparing Early Percutaneous Dilational Tracheotomy to Prolonged Translaryngeal Intubation (Delayed Tracheotomy) in Critically Ill Medical Patients","volume":"32","author":"Rumbak","year":"2004","journal-title":"Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1186\/s13054-015-1138-8","article-title":"Timing of Tracheotomy in ICU Patients: A Systematic Review of Randomized Controlled Trials","volume":"19","author":"Hosokawa","year":"2015","journal-title":"Crit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1177\/08850666231199005","article-title":"A Modified Technique for Percutaneous Dilatational Tracheostomy","volume":"38","author":"Ghotbi","year":"2023","journal-title":"J. Intensiv. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1007\/s00134-013-3023-8","article-title":"Safety of Percutaneous Dilatational Tracheostomy in Patients on Extracorporeal Lung Support","volume":"39","author":"Braune","year":"2013","journal-title":"Intensiv. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1001\/jamaoto.2022.4824","article-title":"Complication Rate of Percutaneous Dilatational Tracheostomy in Critically Ill Adults with Obesity","volume":"149","author":"Roy","year":"2023","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"R110","DOI":"10.1186\/cc6143","article-title":"Percutaneous Tracheostomy in Patients with Severe Liver Disease and a High Incidence of Refractory Coagulopathy: A Prospective Trial","volume":"11","author":"Auzinger","year":"2007","journal-title":"Crit. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1378\/chest.126.2.547","article-title":"Percutaneous Tracheostomy Is Safe in Patients with Severe Thrombocytopenia","volume":"126","author":"Kluge","year":"2004","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1055\/s-0032-1322608","article-title":"Coagulation Disorders Do Not Increase the Risk for Bleeding during Percutaneous Dilatational Tracheotomy","volume":"61","author":"Deppe","year":"2013","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1097\/01.ta.0000413871.29747.ce","article-title":"Anticoagulation Management around Percutaneous Bedside Procedures: Is Adjustment Required?","volume":"72","author":"Barton","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1111\/j.1399-6576.2007.01430.x","article-title":"Tracheostomy: Current Practice on Timing, Correction of Coagulation Disorders and Peri-operative Management\u2014A Postal Survey in the Netherlands","volume":"51","author":"Veelo","year":"2007","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1097\/CCM.0000000000001382","article-title":"Long-Term Outcome Following Tracheostomy in Critical Care","volume":"44","author":"Dempsey","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1378\/chest.118.5.1412","article-title":"A Meta-Analysis of Prospective Trials Comparing Percutaneous and Surgical Tracheostomy in Critically Ill Patients","volume":"118","author":"Freeman","year":"2000","journal-title":"Chest"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s13613-021-00906-5","article-title":"Percutaneous Dilatational Tracheotomy in High-Risk ICU Patients","volume":"11","author":"Krogmann","year":"2021","journal-title":"Ann. Intensiv. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.bja.2024.04.041","article-title":"Antiplatelet and Anticoagulation Use and Risk of Bleeding from Percutaneous Dilatational Tracheostomy Insertion: Systematic Review and Meta-Analysis","volume":"133","author":"Brown","year":"2024","journal-title":"Br. J. Anaesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"329","DOI":"10.4103\/0971-9784.159802","article-title":"Percutaneous Tracheostomy in Patients on Anticoagulants","volume":"18","author":"Pasin","year":"2015","journal-title":"Ann. Card. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1017\/S0022215120002303","article-title":"Safety and Outcomes of Percutaneous Tracheostomy in Coronavirus Disease 2019 Pneumonitis Patients Requiring Prolonged Mechanical Ventilation","volume":"134","author":"Takhar","year":"2020","journal-title":"J. Laryngol. Otol."},{"key":"ref_18","first-page":"387","article-title":"Safety of Percutaneous Dilational Tracheostomy in Coagulopathic Patients","volume":"89","author":"Pandian","year":"2010","journal-title":"Ear Nose Throat J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/j.1365-2044.2007.04979.x","article-title":"Risk Factors Associated with Bleeding during and after Percutaneous Dilational Tracheostomy","volume":"62","author":"Beiderlinden","year":"2007","journal-title":"Anaesthesia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1097\/LBR.0000000000000470","article-title":"Novel Bronchoscopic Management of Airway Bleeding with Absorbable Gelatin and Thrombin Slurry","volume":"25","author":"Peralta","year":"2018","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e474","DOI":"10.1097\/MAT.0000000000002056","article-title":"Tranexamic Acid for Bleeding Management in Adult Patients on Extracorporeal Membrane Oxygenation","volume":"69","author":"Jakowenko","year":"2023","journal-title":"ASAIO J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"244","DOI":"10.4103\/ejb.ejb_27_17","article-title":"Bronchoscopic Instillation of Tranexamic Acid to Control Bronchopulmonary Bleeding","volume":"11","author":"Korraa","year":"2017","journal-title":"Egypt. J. Bronchol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1378\/chest.127.6.2113","article-title":"Bronchoscopy-Guided Topical Hemostatic Tamponade Therapy for the Management of Life-Threatening Hemoptysis","volume":"127","author":"Valipour","year":"2005","journal-title":"Chest"},{"key":"ref_24","first-page":"9","article-title":"Combination of Bronchoscopic Cryoextraction and Argon Plasma Coagulation in Treatment of Total Central Airway Obstruction Caused by Giant Blood Clot Formation in Massive Airway Bleeding","volume":"19","author":"Tenda","year":"2016","journal-title":"Respir. Med. Case Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S1052-3359(25)00827-0","article-title":"Role of Bronchoscopy in Massive Hemoptysis","volume":"11","author":"Cuschieri","year":"2001","journal-title":"Chest Surg. Clin. N. Am."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1016\/j.athoracsur.2020.03.061","article-title":"Limited Efficacy of Thrombolytics for Pump Thrombosis in Durable Left Ventricular Assist Devices","volume":"110","author":"Seese","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"31128","DOI":"10.21037\/acs-2021-cfmcs-34","article-title":"Contemporary Outcomes of Continuous-Flow Biventricular Assist Devices","volume":"10","author":"Farag","year":"2021","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s40138-013-0014-6","article-title":"Anticoagulants: A Review of the Pharmacology, Dosing, and Complications","volume":"1","author":"Alquwaizani","year":"2013","journal-title":"Curr. Emerg. Hosp. Med. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1093\/eurheartj\/ehx391","article-title":"2017 ESC\/EACTS Guidelines for the Management of Valvular Heart Disease","volume":"38","author":"Baumgartner","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.healun.2013.10.009","article-title":"Low-Molecular-Weight Heparin for Anti-Coagulation after Left Ventricular Assist Device Implantation","volume":"33","author":"Sandner","year":"2014","journal-title":"J. Heart Lung Transplant."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1186\/s13019-020-01373-y","article-title":"The Use of Enoxaparin as Bridge to Therapeutic INR after LVAD Implantation","volume":"15","author":"Shah","year":"2020","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/ALN.0000000000004002","article-title":"2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway","volume":"136","author":"Apfelbaum","year":"2021","journal-title":"Anesthesiology"},{"key":"ref_33","first-page":"279","article-title":"Learning Curve for Real-Time Ultrasound-Guided Percutaneous Tracheostomy","volume":"36","author":"Petiot","year":"2017","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"20503121211002321","DOI":"10.1177\/20503121211002321","article-title":"Can We Improve Teaching and Learning of Percutaneous Dilatational Tracheostomy\u2019s Bronchoscopic Guidance?","volume":"9","author":"Abbott","year":"2021","journal-title":"SAGE Open Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4877\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T04:10:23Z","timestamp":1782619823000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4877"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":34,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15134877"],"URL":"https:\/\/doi.org\/10.3390\/jcm15134877","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,23]]}}}