Association between Administration of Antithrombotics and Intraperitoneal Hemorrhage in Patients Undergoing Percutaneous Interventions for Liver Diseases

Akira Asai,Hideko Ohama,Shinya Fukunishi,Kazuhide Higuchi,Yusuke Tsuchimoto,Keisuke Yokohama

doi:10.3390/jcm10112527

Abstract

Currently, percutaneous interventions are essential for diagnosis and treatment of liver diseases. The most frequent complication of percutaneous interventions is intraperitoneal hemorrhage. Recently, the number of patients with liver diseases on antithrombotics has been increasing. This retrospective cohort study aimed to evaluate the risk factors for intraperitoneal hemorrhage in patients after percutaneous interventions for liver diseases. This study included 1025 patients who underwent percutaneous interventions for liver diseases from April 2015 to March 2020. All interventions were performed using an ultrasound-guided approach. The influence of antithrombotic drug administration in patients, who underwent percutaneous interventions according to the guidelines for the American Association for the Study of Liver Disease, was evaluated. Intraperitoneal hemorrhage after percutaneous interventions was detected by computed tomography. Intraperitoneal hemorrhage occurred in nine patients (0.88%); however, these adverse events were not severe. We compared clinical characteristics between the patients with and without intraperitoneal hemorrhage. Although, there was no difference based on the administration of antithrombotics (p = 0.1961), seven of nine patients who showed intraperitoneal hemorrhage received percutaneous treatments (radio frequency ablation or microwave ablation). Therefore, we divided patients who underwent treatments and liver biopsy and then investigated the influence of antithrombotics on the intraperitoneal hemorrhage. After propensity score matching in each patient group, the administration of antithrombotics was not identified as a risk factor for hemorrhage in patients who underwent interventional treatments and patients who underwent liver biopsy. When the antithrombotics were discontinued, according to the guidelines, it may not increase the risk factor for hemorrhage in patients of liver disease who underwent percutaneous interventions.

Highlights

There were 123 million prevalent cases of cirrhosis in 2017 worldwide [1]
There are concerns that the discontinuation of antithrombotic drugs may worsen the disease [19,20]. In this retrospective cohort study of patients who received percutaneous interventions for liver diseases, we studied the incidence rates of intraperitoneal hemorrhage in patients after percutaneous interventions who administrated the antithrombotics according to the guideline
One hundred and sixty patients discontinued these antithrombotic drugs before percutaneous interventions in accordance with the Association for the Study of Liver Disease (AASLD) guidelines for liver biopsy

Summary

Introduction

Percutaneous interventions for liver diseases are currently essential for both diagnosis and treatment [2,3,4]. These interventions were previously performed blindly or guided by computed tomography (CT), recently, most of them have been ultrasound guided [5]. Radio frequency ablation (RFA) and microwave ablation (MWA) are used in these treatments. These are interventions that use ultrasound image guidance to place a needle through the skin into liver tumors. Most cases of intraperitoneal hemorrhage can be managed by observation and hemostatic agents; some cases have been reported to require blood transfusion or become fatal [10,11]

Methods

Results

Conclusion