Abstract
Objectives: Liver biopsy remains the gold standard for diagnosis of chronic liver diseases. Outpatient percutaneous biopsy is generally safe with a mortality rate of 0.17% and hospitalization rate for bleeding of 3%. Von Willebrand disease (vWD) syndrome is the most common inherited hematological disorder with a prevalence of 1% - 3% globally. We sought to study whether vWD increases the risk of bleeding for liver biopsies. Methods: All patients (n = 120) who underwent outpatient percutaneous liver biopsies from 1997 to 2007 were analyzed. Demographics, PT/INR, platelet count, vW antigen and ristocetin induced platelet aggregation were studied. Results: No vWD patients had major bleeding that required transfusion, hospitalization or surgery but 9 (75%) had minor local bleeding and all had ecchymosis, which resolved spontaneously within 24 hours. Conclusions: Patients with vW factor deficiency can undergo percutaneous liver biopsy without major bleeding. Minor bleeding may occur at a slightly higher rate. vWD is not a contraindication to percutaneous liver biopsy.
Highlights
Direct visual documentation of liver disease in its entirety, from aberrant architecture tocytopathology, madeHow to cite this paper: Basu, P.P., Shah, N.J., Aloysius, M.M., Rayapudi, K. and Brown, R. (2015) A Study on the Safety of Liver Biopsy Inpatients with Von Willebrand’s Disease
There was no major bleeding but 9/12 patients in the vW disease group experienced minor bleeding which settled with pressure
Intra-peritoneal hemorrhage is the most disastrousform of bleeding requiring expeditious surgery, others such as intra-parenchymal & biliary, which are self contained by surrounding tissue usually amenable to angiographic embolization [14]-[16]
Summary
Direct visual documentation of liver disease in its entirety, from aberrant architecture tocytopathology, madeHow to cite this paper: Basu, P.P., Shah, N.J., Aloysius, M.M., Rayapudi, K. and Brown, R. (2015) A Study on the Safety of Liver Biopsy Inpatients with Von Willebrand’s Disease. This modality is currently in ubiquitous use for the diagnosis, staging, prognosis and management of a range of infectious, metabolic, autoimmune conditions as well as peri- and post-transplant surveillance. Newer non-invasiveliver assessment modalities such as transient elastography and MR elastography are making their debut in clinical practice, such novelties are unlikely to replace completely liver biopsy as the gold standard, in the foreseeable future [1]. This invasive procedure is still the mainstay along with its associated hazards, affecting morbidity & mortality. Performance of outpatient percutaneous liver biopsies is drifting away from clinicians towards interventional radiologists for enhanced safety and reduced complications
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