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NEW YORK – Joan Rivers, the raspy loudmouth who pounced on America’s obsessions with flab, face-lifts, body hair and other blemishes of neurotic life, including her own, in five decades of caustic comedy that propelled her from nightclubs to television to international stardom, died on Thursday in Manhattan. She was 81.

Her daughter, Melissa Rivers, confirmed her death.

Rivers died at Mount Sinai Hospital, where she was taken last Thursday after reportedly losing consciousness while undergoing a procedure on her vocal cords at a doctor’s office. Doctors at the hospital placed her in a medically induced coma. On Tuesday, her daughter said she was on life support; on Wednesday, she said she had been moved out of intensive care.

The state Health Department is investigating the circumstances that led to her death, a state official said Thursday.

She was one of America’s first successful female stand-up comics in an aggressive vein that had been almost exclusively the province of men, from Don Rickles to Lenny Bruce. And she was a role model and an inspiration for tough-talking comedians like Roseanne Barr and Sarah Silverman and countless others.

Vivacious even as a nipped-and-tucked octogenarian, flitting from coast to coast and stage to studio in a whirl of live and taped shows, publicity stunts and cosmetic surgery appointments, Rivers evolved from a sassy, self-deprecating performer early in her career into a coarser assassin, slashing at celebrities and others with a rapier wit that some critics called comic genius in the bloodletting vein of Bruce. Others called it downright vicious. But if she turned the scowlers off, she left millions in stitches.

“Can we talk?” she demanded in her signature call to gossip and skewer – the brassy Jewish-American princess from Brooklyn and Larchmont, in Westchester County, leveling with the world.

She would take the stage in a demure black sheath and ladylike pearls, a tiny bouffant blonde with a genteel air of sorority decorum. Then she’d stick her finger down her throat and regurgitate the dirt on the rich and famous, the stream-of-conscious take on national heroes and sacrosanct cultural idols.

On Nancy Reagan’s hairdo: “Bulletproof. If they ever combed it, they’d find Jimmy Hoffa.”

On Charlton Heston: “He told us, ‘I got Alzheimer’s.’ Surprise! He’s been wearing his wig sideways for 19 years.”

On Sandra Bullock’s Bottega Veneta gown at the Golden Globes: “It looked like Prince’s old prom dress.” On Queen Elizabeth II: “Gowns by Helen Keller.” “Nice looking. Not at all like her stamp. Wears her watch over the glove, though – tacky.”

On herself, desperate for a man: “My parents had a sign, ‘Last girl before thruway.’ I’d get an obscene phone call. I’d say, ‘Hold on a minute, let me get a cigarette.’ ”

Nothing was sacred.

On her husband’s suicide: “After Edgar killed himself, I went out to dinner with Melissa. I looked at the menu and said, ‘If Daddy were here to see these prices, he’d kill himself all over again.’ ”

Shocked? Offended?

“Oh, grow up!” she advised.

A contemporary of Woody Allen and Bill Cosby, she began doing stand-up routines in nightclubs in the late 1950s, and broke through as a guest on “The Tonight Show” with Johnny Carson in 1965. Over the next two decades she became a regular guest host on the Carson show, a Las Vegas headliner and a television star. In 1986, she hit the big time with a $10 million contract as host of the new Fox network’s weeknight entry, “The Late Show Starring Joan Rivers,” competing directly with her old benefactor.

Then came a series of devastating professional and personal setbacks. She was shunned by Carson, who said that she had never informed him of the Fox offer and who apparently considered her disloyal for accepting it. She insisted that it had had nothing to do with loyalty, and that Fox had wanted her because her ratings were higher and her demographics younger than his.

After less than a year on the air, she was fired by Fox when her ratings slumped. Her husband and manager, Edgar Rosenberg, fell into depression after a heart attack and committed suicide in 1987. Rivers became estranged from her only child, Melissa. Bookings dried up, and her career seemed to be on the rocks.

But, struggling with grief, Rivers traveled for a time, then fell back on the resilience of laughter and revived her comedy career. As she told widows and other sorrowing women at a lecture billed as a “grief seminar” some years later: Think positive. Make a list. “One, I don’t live in Bosnia. Two, I never dated O.J.”

Joan Alexandra Molinsky was born in Brooklyn on June 8, 1933, to Meyer and Beatrice Grushman Molinsky, immigrants from Russia. Her father, a doctor, did comic impersonations of patients. Her mother insisted on piano lessons and private schools for Joan and her sister, Barbara, who grew up in Brooklyn and Larchmont. Joan attended Adelphi Academy in Brooklyn, Connecticut College for Women and Barnard College in Manhattan, graduating Phi Beta Kappa in 1954 with a degree in English.

Dreaming of an acting career, she worked in the publicity department at Lord & Taylor and was a fashion coordinator for the Bond clothing stores. Her marriage to James Sanger, the son of the Bond stores’ merchandiser, was annulled after six months in the 1950s. She married Rosenberg in 1965. Melissa was her only child.

In the early 1960s, she joined the Chicago-based Second City troupe, whose improvisational approach, she said, reinforced her confidence.

She broke through on Carson’s show in 1965. They had an immediate rapport. She told gags about her mother’s struggle to marry her off, and about a motorist who ran over her wig and apologized for killing her dog.

As a frequent guest host on “The Tonight Show” in the ’70s, she toned down her acidity for the national audience and often exploited self-deprecation, a theme of her early nightclub work: “A peeping Tom looked in my window and pulled down the shade.” She was so fat as a child that “I was my own buddy at camp; I began to retreat into myselves.”

Her ratings as host sometimes surpassed Carson’s, and NBC signed her as the sole regular replacement during his eight or nine annual vacation weeks from 1983 to 1986.

After being dismissed by Fox, she reinvented herself as a writer, producer and entrepreneur. She and her daughter reconciled and made a film, “Tears and Laughter: The Joan and Melissa Rivers Story” (1994). They later had their own reality show, “Joan & Melissa: Joan Knows Best?” on the WE cable channel.

For years Rivers marketed her own lines of jewelry and clothing on television shopping channels. Beginning in the mid-1990s, she turned up at the Grammys, the Golden Globes and the Academy Awards, first for the E! Entertainment network and then for the TV Guide Channel, poking a microphone into freshly Botoxed faces on red carpets and asking, “Who are you wearing?” In 2010 she began starring on the E! show “Fashion Police,” where she and a panel gleefully critiqued celebrities’ wardrobes.

A documentary, “Joan Rivers: A Piece of Work,” directed by Ricki Stern and Annie Sundberg, was released in 2010.