Impact of coagulation parameters and spleen size on bleeding complications in patients with primary liver diseases undergoing mini-laparoscopic liver puncture.

Background and Aims Mini-laparoscopic liver biopsy (LLB) is a safe procedure with a low rate of bleeding complications, primarily found in patients with abnormal coagulation parameters (CP) (Frenzel et al. 2012). But current studies question the validity of classical CP such as INR/Quick value with regard to a periprocedural bleeding risk in patients with liver disease.

Methods Retrospective analysis of patients who underwent LLB for unclear hepatopathy (UH) and/or suspected liver cirrhosis (LC). Relevant bleeding (RB) was defined as the use of argon plasma coagula-tion (APC) during LLB. Complication (C) was defined as: liver/abdominal wall hematoma (LHE/AWHE, abdominal bleeding (AB) with the need for surgical intervention.

Results In 376 patients analysed (58% female, median age: 54years), 29% had liver cirrhosis (LC). RB (n=165) was found significantly more often in LC patients (LC vs. non-LC: 79% vs. 29%; Odds Ratio (OR): 9.1, 95% confidence interval (95%CI): 5.3–15.4; p=.0001). Complications (n=6 (1.6%): LHE n=4, AB n=2) were more common in LC patients (4.5% vs. 0.4%; OR: 10.7, 95% CI: 1.44- 126.7; p=.015). Multivariate analysis including Quick/INR, fibrinogen, aPPT, platelets, patients age, size of the biopsy needle, spleen size (cm) and presence of LC, aPTT and LC were significantly associated with RB (aPTT: OR: 1.1, 95% CI: 1.06- 1.19; p=.000; LZ: OR: 6.5, 95%CI: 3.17- 13.5).

Conclusion Severe bleeding complications are rare during LLB. Relevant bleeding occurs especially in LC patients and can be treated with APC. However, with the exception of aPTT, no routine coagulation parameters were associated with bleeding risk.

Publication History

Article published online:
26 January 2022