S2521 Safety of Percutaneous Liver Biopsy Procedure in Patients on Antithrombotic Therapy: A Comparative Multi-Institutional Cohort Study

Introduction: Percutaneous liver biopsy is an important diagnostic tool for various liver diseases. Despite its minimally invasive nature, it poses risks, with bleeding being the most concerning complication. Anticoagulants (ACs) and dual antiplatelet therapy (DAPT) are vital for managing cardiovascular and thromboembolic conditions. Their widespread use can impact the risk of bleeding during liver biopsy. This study aims to assess the safety of percutaneous liver biopsy in patients on anticoagulation (AC) or dual antiplatelet medications (DAPT) using a US-based multi-institutional database. Methods: The study cohorts were identified using the TriNetX US Collaborative Network database based on the CPT code for percutaneous liver biopsy. Patients undergoing these procedures on uninterrupted AC were compared with those who never received any AC prior to or after the procedure. Additionally, patients undergoing this procedure on uninterrupted DAPT were compared with a control group of patients who did not receive any antiplatelets or aspirin prior to or after the procedure. Propensity score matching (1:1) was conducted based on demographics, medications, various comorbidities and labs (INR and platelets count). Hazards Ratios were calculated for outcomes such as post-biopsy bleeding, blood transfusion and mortality within 30 days of the procedure. Results: A total of 7,726 patients were identified in the AC group and a total of 462 in the DAPT group. After propensity score matching, the rates of post biopsy bleeding (HR, 2.03; 95% CI, 1.36-3.02), blood transfusion (HR, 3.66; 95% CI, 3.04-4.39) and overall mortality (HR, 2.60; 95% CI, 2.31-2.93) were significantly higher in the liver biopsy with AC group compared with the liver biopsy without AC group. Meanwhile the group on DAPT compared with those not on DAPT had no significant difference in post biopsy bleeding (HR, 0.70; 95% CI, 0.22-2.20), blood transfusion (HR, 1.40; 95% CI, 0.87-2.26) or overall mortality (HR, 0.92; 95% CI, 0.66-1.29). Conclusion: In this multi-institutional database retrospective cohort study, patients who continued AC during liver biopsy experienced significantly higher rates of post-biopsy bleeding and other adverse outcomes. However, no such increase was observed in patients receiving DAPT compared with the control group. Future prospective studies are needed to confirm these findings, particularly in the DAPT group, where the results may have been affected by the relatively small sample size.