Assessing the Risk of Hemorrhagic Complication following Transjugular Liver Biopsy in Bone Marrow Transplantation Recipients

Osman Ahmed, Thomas J. Ward, Matthew P. Lungren, Mohammed Ahmed Abdelrazek Mohammed, Lawrence V. Hofmann, Daniel Y. Sze, Nishita Kothary

Research output: Contribution to journalArticle

Abstract

Purpose: To determine if recipients of bone marrow transplants (BMTs) are at increased risk of hemorrhagic complications following transjugular liver biopsy (TJLB). Materials and Methods: TJLBs in BMT and non-BMT patients between January 2007 and July 2014 were reviewed. Patient demographic and pre- and postprocedural laboratory data were reviewed. Mean platelet count and International Normalized Ratio were 174,300 × 103/μL ± 107.3 (standard deviation) and 1.2 ± 0.4, respectively, for BMT recipients, compared with 88,100 × 103/μL ± 70.9 and 1.2 ± 0.5, respectively, for non-BMT. Patients in whom hemoglobin level decreased by > 1 g/dL and/or required transfusion within 15 days of TJLB were reviewed to determine the presence of a biopsy-related hemorrhagic complication. Results: A total of 1,600 TJLBs in 1,120 patients were analyzed. Of these, 183 TJLBs in 159 BMT recipients and 1,417 TJLBs in 961 patients non-BMT patients were performed. Thirteen TJLBs were complicated by hemorrhage: five in BMT (2.9%) and eight in the non-BMT cohorts (0.6%; P <.01). Preprocedural platelet counts were within normal range (57-268 × 103/μL) in all but one patient (8 × 103/μL). BMT recipients had an odds ratio of 4.9 (95% confidence interval, 1.25-17.3) for post-TJLB bleeding/hemorrhage compared with those without BMTs (P <.01). Conclusions: TJLB continues to be a safe procedure in the vast majority of patients. However, hemorrhagic complications occurred at a rate of 2.9% in BMT recipients, compared with 0.6% in patients without BMTs, and therefore caution should be exercised when performing TJLB in this group.

Original languageEnglish (US)
JournalJournal of Vascular and Interventional Radiology
DOIs
StateAccepted/In press - Oct 20 2015
Externally publishedYes

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Bone Marrow Transplantation
Bone Marrow
Biopsy
Liver
Transplants
Hemorrhage
Platelet Count
International Normalized Ratio
Reference Values
Hemoglobins
Odds Ratio
Demography
Confidence Intervals

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Assessing the Risk of Hemorrhagic Complication following Transjugular Liver Biopsy in Bone Marrow Transplantation Recipients. / Ahmed, Osman; Ward, Thomas J.; Lungren, Matthew P.; Abdelrazek Mohammed, Mohammed Ahmed; Hofmann, Lawrence V.; Sze, Daniel Y.; Kothary, Nishita.

In: Journal of Vascular and Interventional Radiology, 20.10.2015.

Research output: Contribution to journalArticle

Ahmed, Osman ; Ward, Thomas J. ; Lungren, Matthew P. ; Abdelrazek Mohammed, Mohammed Ahmed ; Hofmann, Lawrence V. ; Sze, Daniel Y. ; Kothary, Nishita. / Assessing the Risk of Hemorrhagic Complication following Transjugular Liver Biopsy in Bone Marrow Transplantation Recipients. In: Journal of Vascular and Interventional Radiology. 2015.
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abstract = "Purpose: To determine if recipients of bone marrow transplants (BMTs) are at increased risk of hemorrhagic complications following transjugular liver biopsy (TJLB). Materials and Methods: TJLBs in BMT and non-BMT patients between January 2007 and July 2014 were reviewed. Patient demographic and pre- and postprocedural laboratory data were reviewed. Mean platelet count and International Normalized Ratio were 174,300 × 103/μL ± 107.3 (standard deviation) and 1.2 ± 0.4, respectively, for BMT recipients, compared with 88,100 × 103/μL ± 70.9 and 1.2 ± 0.5, respectively, for non-BMT. Patients in whom hemoglobin level decreased by > 1 g/dL and/or required transfusion within 15 days of TJLB were reviewed to determine the presence of a biopsy-related hemorrhagic complication. Results: A total of 1,600 TJLBs in 1,120 patients were analyzed. Of these, 183 TJLBs in 159 BMT recipients and 1,417 TJLBs in 961 patients non-BMT patients were performed. Thirteen TJLBs were complicated by hemorrhage: five in BMT (2.9{\%}) and eight in the non-BMT cohorts (0.6{\%}; P <.01). Preprocedural platelet counts were within normal range (57-268 × 103/μL) in all but one patient (8 × 103/μL). BMT recipients had an odds ratio of 4.9 (95{\%} confidence interval, 1.25-17.3) for post-TJLB bleeding/hemorrhage compared with those without BMTs (P <.01). Conclusions: TJLB continues to be a safe procedure in the vast majority of patients. However, hemorrhagic complications occurred at a rate of 2.9{\%} in BMT recipients, compared with 0.6{\%} in patients without BMTs, and therefore caution should be exercised when performing TJLB in this group.",
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AU - Ahmed, Osman

AU - Ward, Thomas J.

AU - Lungren, Matthew P.

AU - Abdelrazek Mohammed, Mohammed Ahmed

AU - Hofmann, Lawrence V.

AU - Sze, Daniel Y.

AU - Kothary, Nishita

PY - 2015/10/20

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N2 - Purpose: To determine if recipients of bone marrow transplants (BMTs) are at increased risk of hemorrhagic complications following transjugular liver biopsy (TJLB). Materials and Methods: TJLBs in BMT and non-BMT patients between January 2007 and July 2014 were reviewed. Patient demographic and pre- and postprocedural laboratory data were reviewed. Mean platelet count and International Normalized Ratio were 174,300 × 103/μL ± 107.3 (standard deviation) and 1.2 ± 0.4, respectively, for BMT recipients, compared with 88,100 × 103/μL ± 70.9 and 1.2 ± 0.5, respectively, for non-BMT. Patients in whom hemoglobin level decreased by > 1 g/dL and/or required transfusion within 15 days of TJLB were reviewed to determine the presence of a biopsy-related hemorrhagic complication. Results: A total of 1,600 TJLBs in 1,120 patients were analyzed. Of these, 183 TJLBs in 159 BMT recipients and 1,417 TJLBs in 961 patients non-BMT patients were performed. Thirteen TJLBs were complicated by hemorrhage: five in BMT (2.9%) and eight in the non-BMT cohorts (0.6%; P <.01). Preprocedural platelet counts were within normal range (57-268 × 103/μL) in all but one patient (8 × 103/μL). BMT recipients had an odds ratio of 4.9 (95% confidence interval, 1.25-17.3) for post-TJLB bleeding/hemorrhage compared with those without BMTs (P <.01). Conclusions: TJLB continues to be a safe procedure in the vast majority of patients. However, hemorrhagic complications occurred at a rate of 2.9% in BMT recipients, compared with 0.6% in patients without BMTs, and therefore caution should be exercised when performing TJLB in this group.

AB - Purpose: To determine if recipients of bone marrow transplants (BMTs) are at increased risk of hemorrhagic complications following transjugular liver biopsy (TJLB). Materials and Methods: TJLBs in BMT and non-BMT patients between January 2007 and July 2014 were reviewed. Patient demographic and pre- and postprocedural laboratory data were reviewed. Mean platelet count and International Normalized Ratio were 174,300 × 103/μL ± 107.3 (standard deviation) and 1.2 ± 0.4, respectively, for BMT recipients, compared with 88,100 × 103/μL ± 70.9 and 1.2 ± 0.5, respectively, for non-BMT. Patients in whom hemoglobin level decreased by > 1 g/dL and/or required transfusion within 15 days of TJLB were reviewed to determine the presence of a biopsy-related hemorrhagic complication. Results: A total of 1,600 TJLBs in 1,120 patients were analyzed. Of these, 183 TJLBs in 159 BMT recipients and 1,417 TJLBs in 961 patients non-BMT patients were performed. Thirteen TJLBs were complicated by hemorrhage: five in BMT (2.9%) and eight in the non-BMT cohorts (0.6%; P <.01). Preprocedural platelet counts were within normal range (57-268 × 103/μL) in all but one patient (8 × 103/μL). BMT recipients had an odds ratio of 4.9 (95% confidence interval, 1.25-17.3) for post-TJLB bleeding/hemorrhage compared with those without BMTs (P <.01). Conclusions: TJLB continues to be a safe procedure in the vast majority of patients. However, hemorrhagic complications occurred at a rate of 2.9% in BMT recipients, compared with 0.6% in patients without BMTs, and therefore caution should be exercised when performing TJLB in this group.

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