Incidence of Bleeding After 15,181 Percutaneous Biopsies and the Role of Aspirin

Department of Radiology, Mayo Clinic, 200 1st St., SW, Rochester, MN 55905, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 03/2010; 194(3):784-9. DOI: 10.2214/AJR.08.2122
Source: PubMed


The objective of our study was to report the incidence of bleeding after imaging-guided percutaneous core biopsy at a single center using a standardized technique.
We performed a retrospective review of percutaneous core biopsies performed at our institution from January 2002 through February 2008. Data were collected at the time of biopsy, and clinical information was obtained 24 hours and 3 months after the biopsy. The specific information that was collected included the results of coagulation studies, aspirin use, the organ biopsied, the size of the biopsy needle, and the number of needle passes. Bleeding complications were defined using the Common Terminology Criteria for Adverse Events (CTCAE, version 3.0) established by the National Cancer Institute.
Among the 15,181 percutaneous core biopsies performed during the study period, 70 hemorrhages (0.5%) that were CTCAE grade 3 or greater were identified within 3 months of biopsy. The incidence of bleeding in patients taking aspirin within 10 days before biopsy was 0.6% (18/3,195), which was not statistically different compared with the incidence of bleeding in those not taking aspirin (52/11,986, 0.4%; p = 0.34). The incidence of bleeding after liver biopsy was 0.5%; kidney biopsy, 0.7%; lung biopsy, 0.2%; pancreas biopsy, 1.0%; and other biopsy, 0.2%. There were significant associations between major bleeding and serum platelet count and international normalized ratio (p < 0.001), although the association between major bleeding and the size of the biopsy needle was not significant (p = 0.97).
The overall incidence of major bleeding after imaging-guided percutaneous core needle biopsy is low. Recent aspirin therapy does not appear to significantly increase the risk of such bleeding complications.

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    • "They performed a retrospective study of 1120 biopsies to define whether it was necessary to stop antiplatelet agents, and their result showed that stopping antiplatelet agents before biopsy was associated with a lower rate of minor complications (31.0 vs. 11.7 %; P = 0.008), but there was no difference in the rate of major complications. Atwell et al. [22] also performed a research about the influence of aspirin on the biopsy, and their result showed that the incidence of bleeding in patients taking aspirin within 10 days before biopsy was 0.6 % (18/3,195), which was not statistically different compared with the incidence of bleeding in those not taking aspirin (52/11,986, 0.4 %; P = 0.34). Interestingly, a meta-analysis of the literature related to peri-procedural aspirin use proved that an approximately 50 % increase in the bleeding rate in those taking aspirin at the time of surgery or biopsy [23]. "
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    ABSTRACT: Renal biopsy is a very important diagnostic tool in the evaluation of renal diseases. However, bleeding remains to be one of the most serious complications in this procedure. Many new techniques have been improved to make it safer. The risk factors and predictors of bleeding after percutaneous renal biopsy have been extensively reported in many literatures, and generally speaking, the common risk factors for renal biopsy complications focus on hypertension, high serum creatinine, bleeding diatheses, amyloidosis, advanced age, gender and so on. Our primary purpose of this review is to summarize current measures in recent years literature aiming at minimizing the bleeding complication after the renal biopsy, including the drug application before and after renal biopsy, operation details in percutaneous renal biopsies, nursing and close monitoring after the biopsy and other kinds of biopsy methods.
    Preview · Article · Aug 2014 · International Urology and Nephrology
    • "However, with the introduction of automated bioptic guns and real-time ultrasound guidance, the risk of complications has been dramatically reduced. Atwell et al. has reported a 6-7% incidence of bleeding after 15,181 percutaneous biopsies.[4] About one in 20 patients will notice mild self-limiting hematuria lasting for a few hours. "
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    ABSTRACT: Post-renal biopsy bleeding refractory to angioembolization usually requires graft nephrectomy as a life-saving measure. Gelatin-thrombin hemostatic matrix injection in the needle tract is a novel attempt to control bleeding in such cases and to salvage the allograft. We hereby describe two cases of post-graft biopsy bleed. Both these patients continued to bleed even after angioembolization. They were shifted to the operating room upon developing hypotension, having received multiple blood transfusions with the intention of performing graft nephrectomy to save their lives. However, bleeding was successfully controlled by using Gelatin-thrombin hemostatic matrix injection in the biopsy needle tract. Patients improved hemodynamically after the procedure. Graft function returned to normal in both the cases. At an average follow-up of 10.4 months, both the patients have shown stable graft functions.
    No preview · Article · Apr 2013 · Indian Journal of Nephrology
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    • "Ainsi, cette équipe pensait raisonnable mais non nécessaire un arrêt de l'aspirine dix jours avant le geste. Cette étude concernait les biopsies percutanées rénales, hépatiques, pulmonaires et pancréatiques [27]. Les auteurs observaient de plus qu'un taux de plaquettes supérieur à 50 000 et un INR inférieur à 1,6 restaient des valeurs seuils raisonnables à respecter avant biopsie. "
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    ABSTRACT: Given the increasing demand for interventional image-guided procedures, radiologists are increasingly sollicited by clinicians to participate in the management of patients prior to and after the interventional procedure, especially with regards to hemostasis. Therefore, radiologists should be familiar with the risk of procedure related hemorrhage. Based on consensus guidelines published by the Society of Interventional Radiology (SIR), the risk of hemorrhage for each interventional procedure will be classified. Recommendations for preprocedure testing based on the type of procedure planned will be reviewed. Finally, limitations of hemostasis parameters will be discussed along with management of anticoagulants and antiplatelet agents before the procedure.
    Full-text · Article · Jul 2011 · Journal de Radiologie
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