Related Experiment Video
Updated: Sep 21, 2025
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Elective percutaneous liver biopsy and use of aspirin
Maxence Emmanuel Reynard1, Jean-François Dufour1,2
1Department for Biomedical Research DBMR, University of Bern, Bern, Switzerland.
Insights
Most hepatologists stop low-dose aspirin before liver biopsies, despite lacking guideline recommendations. This common practice, however, leads to biopsy delays for many patients undergoing percutaneous liver biopsy.
Area of Science:
- Hepatology
- Gastroenterology
- Clinical Practice
Background:
- Percutaneous liver biopsy is a key diagnostic tool in hepatology.
- Bleeding is the most feared complication, though rare.
- Management of patients on low-dose aspirin for liver biopsy is unclear in guidelines.
Purpose of the Study:
- To document current practices regarding low-dose aspirin use in patients undergoing elective percutaneous liver biopsy.
- To investigate the management strategies employed by hepatologists for these patients.
Main Methods:
- An online questionnaire was distributed to members of the American Association for the Study of Liver Diseases (AASLD).
- The questionnaire focused on perioperative management of percutaneous liver biopsy and aspirin use.
- Data from 466 respondents were collected and analyzed.
Main Results:
- 75% of physicians stop low-dose aspirin, on average, 6 days before the procedure.
- This practice persists despite 86% reporting no bleeding complications in patients taking aspirin.
- 61% of respondents reported postponing liver biopsies due to aspirin use.
Conclusions:
- A significant majority of hepatologists stop low-dose aspirin before elective percutaneous liver biopsy.
- This practice is common despite a lack of clear guideline recommendations and supporting evidence.
- The current management approach has logistical implications, causing delays in patient care.
Objectives:
Percutaneous liver biopsy is an essential diagnostic investigation in hepatology. Among complications, which are rare, bleeding is the most feared. Many patients scheduled for a liver biopsy are taking aspirin. Surprisingly no information is available in the literature on this frequent clinical situation. The American Association for the Study of Liver Diseases (AASLD) position paper on percutaneous liver biopsy does not specifically recommend stopping low dose aspirin prior to an elective percutaneous liver biopsy. The European Association for the Study of the Liver also remains unspecific without giving clear recommendation on stopping or not low dose aspirin before the procedure. The aim of this study is to document current practice concerning the management of patients scheduled for an elective percutaneous biopsy and taking low dose aspirin.
Design:
An online questionnaire was designed to gather data on current practice on the perioperative management of percutaneous liver biopsy and use of aspirin.
Settings:
The questionnaire was emailed to AASLD members in September 2018.
Participants:
Four hundred sixty six responses were collected.
Results:
Seventy eight percent postpone elective percutaneous liver biopsy if International Normalised Ratio is ≥1.5 or Quick ≤50%. Ninety five percent postpone biopsy if platelet count is ≤50,000 × 106 /L. Seventy five percent stop low dose aspirin, on average, 6 days prior to the percutaneous liver biopsy. This choice of management does not seem to be related to previous complications since 86% report not having experienced any bleeding in patients taking low dose aspirin. Nevertheless, this practice has logistic consequences since 61% of the respondents postponed a liver biopsy due to intake of low dose aspirin.
Conclusions:
Despite the lack of clear statement in guidelines and evidence supporting this practice, three quarters of physicians practicing in hepatology stop low dose aspirin before elective percutaneous liver biopsy.
More Related Videos
09:49Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization
Published on: December 2, 2013
04:14Incorporation of a Survivable Liver Biopsy Procedure in Mice to Assess Non-alcoholic Steatohepatitis NASH Resolution
Published on: April 16, 2019
