Bleeding risk and complications associated with percutaneous ultrasound-guided liver biopsy in cats

Abstract

Objectives Liver biopsy is necessary for a diagnosis of liver disease; however, post-biopsy bleeding is a concern. The aim of this study was to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound-guided liver biopsy (PUGLB) in cats. Methods The medical records of 30 cats that had a PUGLB were retrospectively reviewed. Using human guidelines, bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was >0 and <-6% or ≥-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. The relationship between ΔPCV and the occurrence of complications and the signalment, initial PCV, coagulation parameters, serum liver enzymes and bilirubin, number of biopsies, histological diagnosis, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration were assessed using Fisher's exact test, ANOVA and Pearson's correlation coefficient, with a P value <0.05 considered significant. Results All cats had a decrease in PCV after biopsy. The mean ΔPCV was -6.9% ± 4.1%. Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) cats, respectively, and non-lethal bleeding complications in 5/30 (16.7%). Cats with complications had a lower pre-biopsy PCV ( P <0.003). Major bleeding was more likely with a diagnosis of hepatic lipidosis ( P = 0.03). There was no correlation between ΔPCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration. Conclusions and relevance A PUGLB is a relatively safe procedure in cats, although many cats have a subclinical decrease in PCV. As conventional coagulation tests did not predict complications or the magnitude of ΔPCV, there is a need for more sensitive indicators of bleeding risk in cats undergoing PUGLB.

ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs

“…Although the risk of hemorrhage post‐biopsy exists in dogs with CH, the prevalence is poorly documented. Published studies of post‐biopsy hemorrhage including a heterogenous group of hepatic disorders indicate a 1.2%‐3.3% incidence of bleeding complications . However, many patients with moderate to severe coagulation abnormalities were pretreated with fresh frozen plasma (FFP) transfusions before liver biopsy likely influencing observed complications.…”

“…At this time, the value of TEG in predicting coagulation status in dogs with CH is unknown. Plasma fibrinogen concentrations seemingly reflect TEG indices of clot strength in dogs with liver disease . As such, plasma fibrinogen concentration is recommended for bleeding risk assessment in CH …”

Hemorrhage and complications associated with percutaneous ultrasound guided liver biopsy in dogs

“…The same has recently been shown in cats where 56.7% of cats had major hemorrhage after PUGLB. 27 The reasons for these discrepancies between dogs and cats and humans are not immediately obvious. An additional 20 dogs became anemic after biopsy due to blood loss.…”

“…30 Anemia before biopsy is also a risk factor for complications in both cats and people undergoing PUGLB. 3,27 In humans, malignancy is a risk factor for major hemorrhage after PUGLB. 3,4 There were only 2 dogs with complications in our study and both of those dogs had neoplasia.…”

“…[22][23][24][25] Although the criteria we chose were defined for human patients on antihemostatic medications, they have been extensively applied to assess hemorrhage in human patients with liver disease and were recently applied to cats. 6,8,11,23,26,27 Under these guidelines major hemorrhage is defined as an absolute decrease in the hemoglobin of 2 g/dL. A fall in hemoglobin of 2 g/dL corresponds with a 6% decrease in PCV, therefore, an absolute decrease in the PCV of 6% was used as a cutoff to define were thrombocytopenic (<150 000/μL) with a median platelet count of 117 000/μL (45 000-148 000/μL).…”