回顾性审查经修订的术前经皮肝活检凝血指南,以确定其实施是否与部门规模的出血并发症增加相关。次要终点是确定这种变化对手术前血液制品(FFP和血小板)利用率的影响。评估血液制品对出血性并发症的影响,并确定出血并发症是否与INR和血小板水平相关。
这个IRB批准的,符合HIPAA标准,回顾性研究回顾了1740例患者的1846例经皮肝活检,比较活检,虽然SIR一致的术前凝血指南已经到位(INR≤1.5,血小板≥50,000微升),不太严格的指南(INR≤2.0,血小板≥25,000µL)。
在部门规模上,与根据SIR指南治疗的患者相比,在采用不太严格的指南后治疗的患者人群中出血性并发症明显减少(1.6%vs.3.4%,p=0.0192),尽管术前FFP显著下降(0.8%与3.9%,p<0.001)和血小板输注(0.3%vs.1.2%,p=0.021)。随着INR增加(p=0.006)和血小板计数减少(p=0.004),个体患者出血性并发症的发生率显着增加。但术前FFP(p=0.64)和/或血小板输注(p=0.5)对出血性并发症发生率无显著影响.
实施不太严格的经皮肝活检术前凝血参数指南(INR≤2.0,血小板≥25,000µL)并未导致科室出血性并发症发生率增加,但术前FFP/血小板给药显著减少。个体患者的出血风险随着INR增加和血小板减少而增加,但术前FFP和/或血小板输注并不能减轻增加的风险.
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.