Madison Radiologists, SC. PO Box 44428, Madison, WI, 53744-4428, USA.
Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA.
Abdom Radiol (NY). 2018 Jun;43(6):1494-1501. doi: 10.1007/s00261-017-1319-9.
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.
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).
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.
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.
回顾修订后的经皮肝活检术前凝血指南，以确定其在科室层面上是否与出血并发症的增加有关。次要终点是确定该变化对术前血制品（FFP 和血小板）使用的影响，评估给予血制品对出血并发症的影响，以及确定出血并发症是否与 INR 和血小板水平有关。
这项经机构审查委员会批准、符合 HIPAA 规定的回顾性研究共纳入了 1740 例患者的 1846 例经皮肝活检，将在 SIR 共识术前凝血指南（INR≤1.5，血小板≥50000µL）下进行的活检与在部门实施修订的、不那么严格的指南（INR≤2.0，血小板≥25000µL）后进行的活检进行比较。
在科室层面上，采用较不严格的指南治疗的患者人群中，出血并发症明显少于采用 SIR 指南治疗的患者（1.6% vs. 3.4%，p=0.0192），尽管术前 FFP（0.8% vs. 3.9%，p<0.001）和血小板输注（0.3% vs. 1.2%，p=0.021）显著减少。随着 INR 的增加（p=0.006）和血小板计数的降低（p=0.004），患者个体出血并发症的发生率显著增加，但术前 FFP（p=0.64）和/或血小板输注（p=0.5）对出血并发症的发生率没有显著影响。
对于经皮肝活检，实施较为宽松的术前凝血参数指南（INR≤2.0，血小板≥25000µL）不会导致科室出血并发症发生率增加，但确实显著减少了术前 FFP/血小板的使用。随着 INR 升高和血小板减少，患者的出血风险确实会增加，但术前 FFP 和/或血小板输注并不能降低这种增加的风险。
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