目的:评估2019年介入放射学学会(SIR)指南对经皮超声引导下肝活检患者的出血风险进行围手术期管理是否与出血不良事件增加相关,术前血液制品利用率的变化,并评估单个学术机构的指南遵守率。方法:超声引导下经皮肝活检(2019年1月至2023年1月)进行回顾性分析(n=504),比较使用2012SIR术前凝血指南(n=266)和实施2019SIR术前指南(n=238)后的活检.人口统计,术前输血,实验室,并对临床资料进行综述。进行图表审查以评估定义为导致输血的主要出血不良事件的发生率。栓塞,手术,或死亡。结果:2019年SIR围手术期指南的实施导致与血液制品管理相关的指南不合规减少,从5.3%到1.7%(P=0.01)。术前输血率与指南前后相同,为0.8%。出血不良事件发生率无统计学显著变化,指南前0.8%与指南后0.4%(P=1.0)。结论:实施2019年SIR指南,对接受经皮超声引导肝活检的患者进行出血风险的围手术期管理,并未导致出血不良事件或术前输血率增加。该指南可以在临床实践中安全实施,不会增加主要不良事件。
Purpose: To evaluate if implementation of the 2019 Society of Interventional Radiology (SIR)
guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy is associated with increased haemorrhagic adverse events, change in pre-procedural blood product utilization, and evaluation of
guideline compliance rate at a single academic institution. Methods: Ultrasound guided percutaneous liver biopsies from (January 2019-January 2023) were retrospectively reviewed (n = 504), comparing biopsies performed using the 2012 SIR pre-procedural coagulation guidelines (n = 266) to those after implementation of the 2019 SIR pre-procedural
guidelines (n = 238). Demographic, preprocedural transfusion, laboratory, and clinical data were reviewed. Chart review was conducted to evaluate the incidence of major bleeding adverse events defined as those resulting in transfusion, embolization, surgery, or death. Results: Implementation of the 2019 SIR periprocedural
guidelines resulted in reduced
guideline non-compliance related to the administration of blood products, from 5.3% to 1.7% (P = .01). The rate of pre-procedural transfusion remained the same pre and post
guidelines at 0.8%. There was no statistically significant change in the incidence of bleeding adverse events, 0.8% pre guidelines versus 0.4% post (P = 1.0). Conclusion: Implementation of the 2019 SIR guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy did not result in an increase in bleeding adverse events or pre-procedural transfusion rates. The guidelines can be safely implemented in clinical practice with no increase in major adverse events.