Davis C L, Chandler W L
Department of Medicine, University of Washington Medical Center, Seattle, USA.
J Am Soc Nephrol. 1995 Oct;6(4):1250-5. doi: 10.1681/ASN.V641250.
The ability of prebiopsy coagulation assays to predict mild postbiopsy bleeding was evaluated in renal transplant patients undergoing renal allograft biopsy (N = 120). The coagulation assays studied included the bleeding time, prothrombin time, partial thromboplastin time, platelet count, and thromboelastograph (TEG). Coagulation results were defined as abnormal if they fell outside the established normal reference range. Bleeding was defined as a drop in the hematocrit equal to or more than 4 points 6 h after the procedure or ultrasound evidence of a new perirenal hematoma. Overall, 21% of patients showed evidence of mild bleeding. Of those who bled, 78% had normal results on all coagulation tests, indicating that most mild bleeding was not associated with coagulation abnormalities. Of the assays tested, only abnormal TEG:angle (P < 0.01) and TEG:k (P < 0.04) values were associated with an increased risk of bleeding. Bleeding times were not predictive of an increased risk of postbiopsy bleeding; five patients had abnormal bleeding times ranging from 10 to 20 min of whom only one bled. All prothrombin time, partial thromboplastin time, and platelet count abnormalities were mild (e.g., no prothrombin times longer than 15 s, no platelet counts below 129,000/microL); none of these assays predicted postbiopsy bleeding. Other clinical characteristics, including patient age, sex, serum creatinine, blood pressure (if less than 160/90 mm Hg), number of biopsy passes, or renal pathology, did not appear to influence bleeding after biopsy. It was concluded that most bleeding after transplant renal biopsy was not associated with coagulation abnormalities and that the TEG was the best assay for detecting mild coagulation abnormalities associated with an increased risk of bleeding.
对120例接受同种异体肾移植活检的肾移植患者进行了活检前凝血试验预测活检后轻度出血能力的评估。所研究的凝血试验包括出血时间、凝血酶原时间、部分凝血活酶时间、血小板计数和血栓弹力图（TEG）。如果凝血结果超出既定的正常参考范围，则定义为异常。出血定义为术后6小时血细胞比容下降等于或超过4个百分点，或超声显示有新的肾周血肿。总体而言，21%的患者有轻度出血迹象。在出血的患者中，78%的患者所有凝血试验结果正常，这表明大多数轻度出血与凝血异常无关。在所测试的试验中，只有异常的TEG：角度（P<0.01）和TEG：k（P<0.04）值与出血风险增加相关。出血时间不能预测活检后出血风险增加；5例患者出血时间异常，范围为10至20分钟，其中只有1例出血。所有凝血酶原时间、部分凝血活酶时间和血小板计数异常均较轻（例如，凝血酶原时间不超过15秒，血小板计数不低于129,000/微升）；这些试验均未预测活检后出血。其他临床特征，包括患者年龄、性别、血清肌酐、血压（如果低于160/90毫米汞柱）、活检穿刺次数或肾脏病理，似乎均不影响活检后的出血情况。研究得出结论，移植肾活检后的大多数出血与凝血异常无关，TEG是检测与出血风险增加相关的轻度凝血异常的最佳试验。
