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Percutaneous liver biopsy and revised coagulation guidelines: a 9-year experience

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Abstract

Purpose

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).

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Madison Radiologists, SC. PO Box 44428, Madison, WI, 53744-4428, USA

    Douglas R. Kitchin

  2. Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA

    Alejandro Munoz del Rio, Michael Woods & J. Louis Hinshaw

  3. St. Paul Radiology, 166 4th St East, St. Paul, MN, 55101, USA

    Lucas Ludeman

Authors
  1. Douglas R. Kitchin
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  2. Alejandro Munoz del Rio
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  3. Michael Woods
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  4. Lucas Ludeman
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  5. J. Louis Hinshaw
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Corresponding author

Correspondence to Douglas R. Kitchin.

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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.

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Kitchin, D.R., del Rio, A.M., Woods, M. et al. Percutaneous liver biopsy and revised coagulation guidelines: a 9-year experience. Abdom Radiol 43, 1494–1501 (2018). https://doi.org/10.1007/s00261-017-1319-9

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  • DOI: https://doi.org/10.1007/s00261-017-1319-9

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