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Platelet and INR Thresholds and Bleeding Risk in Ultrasound Guided Percutaneous Liver Biopsy: A Before-After
Chloe DesRoche1, Jeannie Callum2, Aiden Scholey2
1School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
Insights
The 2019 Society of Interventional Radiology (SIR) guidelines for liver biopsy bleeding risk management can be safely implemented. These updated guidelines did not increase adverse bleeding events or blood product use in patients undergoing percutaneous ultrasound guided liver biopsy.
Area of Science:
- Interventional Radiology
- Hepatology
- Patient Safety
Background:
- Percutaneous liver biopsy is a common procedure with potential bleeding risks.
- Adherence to pre-procedural guidelines is crucial for minimizing complications.
- The Society of Interventional Radiology (SIR) updated its guidelines in 2019 for managing bleeding risk.
Purpose of the Study:
- To assess the impact of implementing the 2019 SIR guidelines on bleeding adverse events.
- To evaluate changes in pre-procedural blood product utilization after guideline adoption.
- To determine the guideline compliance rate following the 2019 SIR update.
Main Methods:
- Retrospective review of 504 percutaneous ultrasound-guided liver biopsies (January 2019-January 2023).
- Comparison of biopsies performed under 2012 SIR guidelines (n=266) versus 2019 SIR guidelines (n=238).
- Analysis of demographic, laboratory, transfusion, and clinical data; chart review for major bleeding events.
Main Results:
- Guideline non-compliance regarding blood product administration decreased from 5.3% to 1.7% (P=.01).
- Pre-procedural transfusion rates remained stable at 0.8% before and after guideline implementation.
- No significant change in bleeding adverse events was observed (0.8% pre-guidelines vs. 0.4% post-guidelines; P=1.0).
Conclusions:
- The 2019 SIR guidelines can be safely implemented for percutaneous ultrasound-guided liver biopsies.
- Adoption of the 2019 SIR guidelines did not lead to an increase in bleeding complications.
- Implementation of the updated guidelines improved compliance without compromising patient safety regarding bleeding risk.
Abstract:
Purpose: To evaluate if implementation of the 2019 Society of Interventional Radiology (SIR) guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy is associated with increased haemorrhagic adverse events, change in pre-procedural blood product utilization, and evaluation of guideline compliance rate at a single academic institution. Methods: Ultrasound guided percutaneous liver biopsies from (January 2019-January 2023) were retrospectively reviewed (n = 504), comparing biopsies performed using the 2012 SIR pre-procedural coagulation guidelines (n = 266) to those after implementation of the 2019 SIR pre-procedural guidelines (n = 238). Demographic, preprocedural transfusion, laboratory, and clinical data were reviewed. Chart review was conducted to evaluate the incidence of major bleeding adverse events defined as those resulting in transfusion, embolization, surgery, or death. Results: Implementation of the 2019 SIR periprocedural guidelines resulted in reduced guideline non-compliance related to the administration of blood products, from 5.3% to 1.7% (P = .01). The rate of pre-procedural transfusion remained the same pre and post guidelines at 0.8%. There was no statistically significant change in the incidence of bleeding adverse events, 0.8% pre guidelines versus 0.4% post (P = 1.0). Conclusion: Implementation of the 2019 SIR guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy did not result in an increase in bleeding adverse events or pre-procedural transfusion rates. The guidelines can be safely implemented in clinical practice with no increase in major adverse events.
