Thrombocyte Aggregation Inhibitors Are Important
In the review article entitled “The indications for liver biopsy” (1), the recommendations for coagulation say: “For safety, the platelet count should be above 50/nL, and the Quick value over 50% (e4).” Unfortunately the authors do not make any mention of platelet aggregation inhibitors.
In context of an expert report, the case of a patient was worked up in which, after a biopsy of a hepatic nodule with continued intake of acetylsalicylic acid, a massive hemorrhage occurred at the puncture site. The insurers declared non-liability because no guidelines or binding regulations exist in this scenario. The German-language literature does, however, provide recommendations according to which platelet aggregation inhibitors should be stopped in good time before a liver biopsy is undertaken (2, 3).
It would therefore be of general interest to find out where the authors stand with regard to this question.
Prof. Dr. med. Georg Schultze
Conflict of interest statement
The author has received honoraria for consultancy services from the medical service of the health insurance companies in Germany (Medizinischer Dienst der Krankenversicherung, MDK) Saarland.
|1.||Tannapfel A, Dienes HP, Lohse AW: The indications for liver biopsy. Dtsch Arztebl Int 2012; 109(27–28): 477–83. VOLLTEXT|
|2.||Glaser J, Pausch J: Perkutane Leberbiopsie – Empfehlungen der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) für die Durchführung endoskopischer Untersuchungen. 3rd edition. Demeter-Verlag Stuttgart 2002; 296–9. www.dgvs.de/media/6.1.Leberbiopsie.pdf.|
|3.||Semmo N, et al.: Die perkutane Leberbiopsie. Dtsch Med Wochenschr 2007; 132: 2643–5. CrossRef MEDLINE|