Predicting bleeding after liver biopsy using comprehensive clinical and laboratory investigations: A prospective analysis of 302 procedures.
Predicting bleeding after liver biopsy using comprehensive clinical and laboratory investigations: A prospective analysis of 302 procedures.
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DOI：
10.1111/jth.15888
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发表时间：
2022-12
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影响因子：
--
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中科院分区：
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肝活检有出血并发症的小风险。没有经过验证的临床或实验室工具有助于预测肝活检相关出血。目的：确定全面止血试验和/或临床问卷是否可以识别有肝活检相关出血风险的患者。前瞻性纳入计划连续进行肝活检并住院过夜的患者。在肝活检前进行常规止血试验、血小板功能分析仪100、血栓弹性测定、凝血酶生成测定、血浆凝块溶解时间和临床问卷调查。出血定义为肝活检后24小时系统超声检查发现肝血肿或新的游离液，或腹腔内已有游离液的患者血红蛋白水平下降2 g/dL或以上。其中173例经皮肝活检，129例经颈静脉肝活检。出血21次（7%）；20例基于超声检查标准，1例基于实验室标准。在整个研究组中，没有一项止血试验和临床问卷的任何项目与肝活检相关出血相关。在针对经皮肝活检、经颈静脉肝活检或肝硬化患者的亚组分析中也获得了相同的结果。肝活检相关出血患者在肝活检后2小时的疼痛更为常见（55%比23% p = 0.002）。广泛的止血检查，包括全面的止血试验，并不能改善肝活检相关出血的预测。肝活检后2小时的疼痛应该提醒临床医生手术相关出血的可能性。
Liver biopsy carries a small risk of bleeding complications. No validated clinical or laboratory tool helps predict liver biopsy–related bleeding. To determine whether global hemostasis tests and/or a clinical questionnaire could identify patients at risk of liver biopsy–related bleeding. Consecutive patients scheduled for liver biopsy with an overnight hospital stay were prospectively included. Before liver biopsy, routine hemostasis tests, Platelet Function Analyzer 100, thromboelastometry, thrombin generation assay, plasma clot lysis time, and a clinical questionnaire were performed. Bleeding was defined as a liver hematoma or new free fluid on a systematic ultrasound performed 24 h after liver biopsy or a decrease in hemoglobin level of 2 g/dL or more in patients with pre‐existing free fluid in the abdominal cavity. Three hundred two patients were included: 173 underwent percutaneous and 129 transjugular liver biopsy. There were 21 bleeding episodes (7%); 20 based on ultrasonographic criteria, 1 on laboratory criteria. None of the hemostasis tests and no item of the clinical questionnaire were associated with liver biopsy–related bleeding in the overall study group. Same results were obtained in subgroup analyses focusing on patients who underwent percutaneous liver biopsy, transjugular liver biopsy, or on patients with cirrhosis. Pain 2 h after liver biopsy was more frequent in patients with liver biopsy–related bleeding (55% vs. 23% p = .002). An extensive hemostasis workup, including global hemostasis assays, does not improve prediction of liver biopsy–related bleeding. Pain 2 h after liver biopsy should alert the clinician to the possibility of procedure‐related bleeding.
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DOI：
10.1097/meg.0000000000000442
发表时间：
2015-11-01
影响因子：
2.1
作者：
Venon, Wilma Debernardi;Ponzo, Paola;Marzano, Alfredo
通讯作者：
Marzano, Alfredo
影响因子：
13.5
作者：
Drolz, Andreas;Horvatits, Thomas;Fuhrmann, Valentin
通讯作者：
Fuhrmann, Valentin
影响因子：
10.4
作者：
Rodeghiero, F.;Tosetto, A.;Lillicrap, D.
通讯作者：
Lillicrap, D.
影响因子：
3.3
作者：
Vinholt, Pernille Just;Hvas, Anne-Mette;Nybo, Mads
通讯作者：
Nybo, Mads
影响因子：
1.2
作者：
Liane, Billy-Joe;Dooley, Guy;Morales-Cardona, Amilcar L.
通讯作者：
Morales-Cardona, Amilcar L.