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Complication Rate of Percutaneous Liver Biopsies Among Persons With Advanced Chronic Liver Disease in the HALT-C Trial

Published:April 02, 2010DOI:https://doi.org/10.1016/j.cgh.2010.03.025

      Background & Aims

      Although percutaneous liver biopsy is a standard diagnostic procedure, it has drawbacks, including risk of serious complications. It is not known whether persons with advanced chronic liver disease have a greater risk of complications from liver biopsy than patients with more mild, chronic liver disease. The safety and complications of liver biopsy were examined in patients with hepatitis C–related bridging fibrosis or cirrhosis who were enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis trial.

      Methods

      Standard case report forms from 2740 liver biopsies performed at 10 study sites between 2000 and 2006 were reviewed for serious adverse events, together with information from questionnaires completed by investigators about details of biopsy techniques used at each hospital.

      Results

      There were 29 serious adverse events (1.1%); the most common was bleeding (16 cases; 0.6%). There were no biopsy-related deaths. The bleeding rate was higher among patients with platelet counts of 60,000/mm3 or less and among those with an international normalized ratio of 1.3 or greater, although none of the patients with an international normalized ratio greater than 1.5 bled. Excluding subjects with a platelet count of 60,000/mm3 or less would have reduced the bleeding rate by 25% (4 of 16), eliminating only 2.8% (77 of 2740) of biopsies. Operator experience, the type of needle used, or the performance of the biopsy under ultrasound guidance did not influence the frequencies of adverse events.

      Conclusions

      Approximately 0.5% of persons with hepatitis C and advanced fibrosis experienced potentially serious bleeding after liver biopsy; risk increased significantly in patients with platelet counts of 60,000/mm3 or less.

      Keywords

      Abbreviations used in this paper:

      AE (adverse event), HALT-C (Hepatitis C Antiviral Long-Term Treatment against Cirrhosis), INR (international normalized ratio), PT (prothrombin time), SAE (serious adverse event)
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      Linked Article

      • Percutaneous Liver Biopsy
        Clinical Gastroenterology and HepatologyVol. 9Issue 3
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          The article by Seeff et al1 on the complication rate of liver biopsies is a welcome contribution to this subject. To be able to properly perform a liver biopsy (LB) is essential to any institution that wants to excel in the practice of clinical hepatology and hepatological research. However, this procedure is invasive and, albeit more than reasonably safe, carries the risk of significant complications and even death.
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