Elective percutaneous liver biopsy and use of aspirin

Objectives Percutaneous liver biopsy is an essential diagnostic investigation in hepatology. Among complications, which are rare, bleeding is the most feared. Many patients scheduled for a liver biopsy are taking aspirin. Surprisingly no information is available in the literature on this frequent clinical situation. The American Association for the Study of Liver Diseases (AASLD) position paper on percutaneous liver biopsy does not specifically recommend stopping low dose aspirin prior to an elective percutaneous liver biopsy. The European Association for the Study of the Liver also remains unspecific without giving clear recommendation on stopping or not low dose aspirin before the procedure. The aim of this study is to document current practice concerning the management of patients scheduled for an elective percutaneous biopsy and taking low dose aspirin. Design An online questionnaire was designed to gather data on current practice on the perioperative management of percutaneous liver biopsy and use of aspirin. Settings The questionnaire was emailed to AASLD members in September 2018. Participants Four hundred sixty six responses were collected. Results Seventy eight percent postpone elective percutaneous liver biopsy if International Normalised Ratio is >= 1.5 or Quick <= 50%. Ninety five percent postpone biopsy if platelet count is <= 50,000 x 10(6)/L. Seventy five percent stop low dose aspirin, on average, 6 days prior to the percutaneous liver biopsy. This choice of management does not seem to be related to previous complications since 86% report not having experienced any bleeding in patients taking low dose aspirin. Nevertheless, this practice has logistic consequences since 61% of the respondents postponed a liver biopsy due to intake of low dose aspirin. Conclusions Despite the lack of clear statement in guidelines and evidence supporting this practice, three quarters of physicians practicing in hepatology stop low dose aspirin before elective percutaneous liver biopsy.

Automated summary

This study investigates the actual management of patients scheduled for an elective percutaneous biopsy and taking low dose aspirin. Despite the lack of clear guidelines or evidence, 75% of physicians in hepatology choose to stop low dose aspirin before the procedure.