Bleeding Complications following Image-Guided Percutaneous Biopsies in Patients Taking Clopidogrel-A Retrospective Review

Abstract

Purpose: To report incidence of bleeding after image-guided percutaneous core needle biopsy performed in patients taking clopidogrel within 5 days.

Materials and methods: This was a retrospective review of image-guided percutaneous core needle biopsies performed in patients with clopidogrel use within 5 days of the procedure between January 2002 and November 2014. Data including biopsy site, needle size, number of samples, and serum coagulation studies were collected. Routine follow-up of patients was performed 24-72 hours after biopsy. Major bleeding complications were defined as grade 3 or greater using Common Terminology Criteria for Adverse Events. There were 63 deep biopsies performed in 63 patients with recent use of clopidogrel. Mean time of clopidogrel abstinence before biopsy was 2.9 days ± 1.9 (median 3 days). Clopidogrel had been taken within 24 hours of the biopsy by 12 patients. There were 48 patients (76%) who also took aspirin within 5 days of the procedure. The most common procedure was liver biopsy (21/63; 33%), followed by lung (12/63; 19%), abdominal/pelvic/retroperitoneal mass (12/63; 19%), and renal (11/63; 17%) biopsies.

Results: A major bleeding complication (1/63; 1.6%) occurred after injury to an intercostal artery during lung biopsy, which was successfully treated with coil embolization. No minor bleeding complications were identified.

Conclusions: In this study comprising a small number of patients undergoing various biopsy procedures, recent clopidogrel use was associated with a very low incidence of major bleeding.