The Impact of Antithrombotic Therapy on Bleeding Complications in Percutaneous Liver Biopsy: Are the Withdrawal Criteria of Antithrombotic Agents in Japan Gastroenterological Endoscopy Society Guidelines for Gastroenterological Endoscopy Useful?

Background: Bleeding is the most important complication of percutaneous liver biopsy. However, there are many unknowns regarding the management of antithrombotic agents in percutaneous liver biopsy. We investigated whether percutaneous liver biopsy could be performed safely by withdrawal of antithrombotic agents in accordance with the criteria of gastroenterological endoscopy guidelines. Methods: A retrospective study was conducted on patients who underwent percutaneous liver biopsy. Antithrombotic agents were discontinued in accordance with the withdrawal criteria in the Japan Gastroenterological Endoscopy Society guidelines for gastroenterological endoscopy. Results: A total of 630 cases were enrolled, including 64 cases receiving antithrombotic therapy. Bleeding complications occurred in 6.7% of cases with antithrombotic therapy and 2.1% of patients without antithrombotic therapy, with no significant difference between the two groups (p = 0.069). Major bleeding requiring surgical intervention or transarterial embolization was not observed in cases with antithrombotic therapy. Only one case (1.6%) developed thromboembolism after withdrawal of antithrombotic agents. Even after propensity score matching, there was no significant difference in the bleeding complication rates between the cases with and without antithrombotic therapy in either tumor biopsy (p = 0.599) and non-tumor biopsy (p = 0.440). Univariate and multivariate analysis revealed that low platelet count (≤10 × 104/μL) was a significant risk factor for bleeding complications (OR = 1.07, 95%CI 1.01–1.15, p = 0.034), whereas antithrombotic therapy was not a significant factor (OR = 2.7, 95%CI 0.79–9.22, p = 0.114). Conclusions: This study suggests that percutaneous liver biopsy may be performed safely in cases receiving antithrombotic therapy by discontinuation of antithrombotic agents in accordance with the withdrawal criteria of Japan Gastroenterological Endoscopy Society guidelines for gastroenterological endoscopy.