Department of Radiology, Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste 104, Chicago, IL 60637.
Department of Radiology, University of Chicago Medical Center, Chicago, IL.
AJR Am J Roentgenol. 2020 Nov;215(5):1279-1285. doi: 10.2214/AJR.19.22414. Epub 2020 Sep 9.
This study evaluates the prevalence of an abnormal international normalized ratio (INR) and platelet count before image-guided percutaneous needle biopsies over a 10-year period, comparing data from patients with and those without known conditions predisposing to coagulopathy. A review of electronic medical records identified patients who were scheduled for a biopsy in a single institution's radiology department for the period of 2007-2016. The following information was recorded: demographic data, patient history of conditions that predispose to bleeding (e.g., liver disease, anticoagulant therapy, history of coagulopathy), and INR and platelet values within 30 days before biopsy. Data were stratified by biopsies that were performed versus those that were cancelled. Over 10 years, 3864 percutaneous biopsies were performed, and 6371 were cancelled. Approximately half of the biopsies (48.2%) were performed in patients without a predisposing condition; of those patients, 0.8% and 0.1% had an INR greater than 1.5 and greater than 1.8, respectively, and 0.4% had a platelet count of 50,000/μL or less (≤ 50 × 10/L). In patients with no known predisposing condition, 0.6% and 0.0% of biopsies cancelled were in patients who had an INR greater than 1.5 and greater than 1.8, respectively, and 0.1% of biopsies cancelled were in patients who had a platelet count of 50,000/μL or less. Ordering prebiopsy testing of patients with no predisposing conditions for the 1864 percutaneous biopsies performed over the 10-year study period resulted in more than $850,000 in laboratory-related health care costs. Our results suggest that the cost of identifying one abnormal INR is nearly $700,000. For patients without any known bleeding risks who are scheduled to undergo image-guided percutaneous biopsies, identifying an abnormal INR or abnormal platelet count is rare. Eliminating this testing in patients without predisposing conditions has the potential to create savings in costs and time for both physicians and patients.
这项研究评估了在 10 年期间，进行影像学引导经皮穿刺活检前，国际标准化比值（INR）和血小板计数异常的患病率，并比较了有和无已知易导致凝血障碍的疾病的患者的数据。回顾电子病历，确定了 2007 年至 2016 年期间在一家机构放射科接受活检的患者。记录了以下信息：人口统计学数据、患者易导致出血的疾病史（例如，肝病、抗凝治疗、凝血障碍史）、以及活检前 30 天内的 INR 和血小板值。数据根据进行的活检和取消的活检进行分层。10 年间，共进行了 3864 例经皮活检，取消了 6371 例。大约一半的活检（48.2%）是在没有易患疾病的患者中进行的；在这些患者中，分别有 0.8%和 0.1%的 INR 大于 1.5 和大于 1.8，0.4%的血小板计数为 50000/μL 或更低（≤ 50×10/L）。在无已知易患疾病的患者中，分别有 0.6%和 0.0%的取消活检的 INR 大于 1.5 和大于 1.8，0.1%的取消活检的血小板计数为 50000/μL 或更低。在 10 年研究期间进行的 1864 例经皮活检中，对无易患疾病的患者进行术前检测，导致实验室相关医疗费用超过 85 万美元。我们的结果表明，识别一个异常 INR 的成本接近 70 万美元。对于没有任何已知出血风险且计划进行影像学引导经皮活检的患者，发现异常 INR 或异常血小板计数的情况很少见。在没有易患疾病的患者中消除这种检测，有可能为医生和患者节省成本和时间。
