Scott D A, Netchvolodoff C V, Bacon B R
Department of Medicine, Overton Brooks Veterans Administration Medical Center, Shreveport, Louisiana.
Am J Gastroenterol. 1991 Apr;86(4):503-5.
Guidelines for the management of patients receiving chronic anticoagulation therapy who require liver biopsy are not clearly defined. In patients with normal coagulation, liver biopsy is a relatively safe procedure with a morbidity of less than 0.1% and a mortality of less than 0.01%. We report a patient with a prosthetic aortic valve who developed a large subcapsular hematoma 12 days after a percutaneous liver biopsy as a consequence of warfarin toxicity. Based on the experience with this patient, reinstitution of anticoagulant therapy should be avoided for at least 72 h after a percutaneous liver biopsy. Intravenous heparin should be resumed first, and warfarin added if no bleeding has occurred after an additional 48-72 h. The prothrombin time should be maintained at 1.5 times the baseline.
对于需要进行肝活检的接受慢性抗凝治疗的患者，其管理指南尚未明确界定。在凝血功能正常的患者中，肝活检是一项相对安全的操作，发病率低于0.1%，死亡率低于0.01%。我们报告了一名人工主动脉瓣置换术后患者，因华法林毒性，在经皮肝活检后12天出现了巨大的肝包膜下血肿。基于该患者的经验，经皮肝活检后至少72小时应避免重新开始抗凝治疗。应首先恢复静脉注射肝素，如果在额外的48 - 72小时后没有出血情况，再添加华法林。凝血酶原时间应维持在基线的1.5倍。
