Percutaneous liver biopsy and revised coagulation guidelines: a 9-year experience
- 324 Downloads
To retrospectively review revised pre-procedural coagulation guidelines for percutaneous liver biopsy to determine whether their implementation is associated with increased hemorrhagic complications on a departmental scale. Secondary endpoints were to determine the effect of this change on pre-procedural blood product (FFP and platelet) utilization, to evaluate the impact of administered blood products on hemorrhagic complications, and to determine whether bleeding complications were related to INR and platelet levels.
Materials and methods
This IRB-approved, HIPAA-compliant, retrospective study reviewed 1846 percutaneous liver biopsies in 1740 patients, comparing biopsies performed, while SIR consensus pre-procedural coagulation guidelines were in place (INR ≤ 1.5, platelets ≥50,000 µL) to those performed after departmental implementation of revised, less stringent guidelines (INR ≤ 2.0, platelets ≥25,000 µL).
On a departmental scale, there were significantly fewer hemorrhagic complications in the population of patients treated after adoption of less stringent guidelines as compared to those treated under the SIR guidelines (1.6% vs. 3.4%, p = 0.0192) despite a significant decrease in pre-procedural FFP (0.8% vs. 3.9%, p < 0.001) and platelet transfusions (0.3% vs. 1.2%, p = 0.021). Individual patient hemorrhagic complication rates significantly increased as INR increased (p = 0.006) and platelet counts decreased (p = 0.004), but pre-procedural FFP (p = 0.64) and/or platelet transfusion (p = 0.5) did not have a significant impact on hemorrhagic complication rates.
Implementation of less stringent pre-procedural coagulation parameter guidelines for percutaneous liver biopsy (INR ≤ 2.0, platelets ≥25,000 µL) did not result in an increase in departmental hemorrhagic complication rates but did significantly decrease pre-procedural FFP/platelet administration. An individual patient’s bleeding risk does increase as INR increases and platelets decrease, but pre-procedural FFP and/or platelet transfusion did not mitigate that increased risk.
KeywordsLiver Biopsy Pre-procedural Coagulation Guidelines
Compliance with ethical standards
Conflicts of interest
J. Louis Hinshaw: Shareholder and Consultant for NeuWave Medical, a company which manufactures microwave ablation technology. Shareholder, Novleos, a company which manufactures tumor radiopharmaceuticals. All others—none.
- 5.Minuk GY, Sutherland LR, Wiseman DA, MacDonald FR, Ding DL (1987) Prospective study of the incidence of ultrasound-detected intrahepatic and subcapsular hematomas in patients randomized to 6 or 24 hours of bed rest after percutaneous liver biopsy. Gastroenterology 92(2):290–293CrossRefPubMedGoogle Scholar
- 19.Institute NC (2009) Common Terminology Criteria for Adverse Events v4.0.Google Scholar
- 20.R Development Core Team (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing V, Austria. ISBN 3-900051-07-0. http://www.R-project.org.
- 25.FDA (2010) Fatalities reported to FDA following blood collection and transfusionGoogle Scholar