Open AccessRoutine haemostasis testing before transplanted kidney biopsy: a cohort study
Author(s) -
Kuiper Gerhardus J.A.J.M.,
Christiaans Maarten H.L.,
Mullens Monique H.J.M.,
ten Cate Hugo,
Hamulýak Karly,
Henskens Yvonne M.C.
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13090
Subject(s) - medicine , biopsy , surgery , nephrology , odds ratio , blood transfusion , bleeding time , urology , platelet , gastroenterology , platelet aggregation
Summary Kidney biopsy can result in bleeding complications. Prebiopsy testing using bleeding time ( BT ) is controversial. New whole blood haemostasis tests, such as platelet function analyser‐100 ( PFA ‐100) and multiple electrode aggregometry ( MEA ), might perform better. We postulated that PFA ‐100 would be suitable to replace BT prebiopsy. In 154 patients, transplanted kidney biopsies were performed after measurement of bleeding time, PFA ‐100, MEA and mean platelet volume ( MPV ). Bleeding outcome (haemoglobin (Hb) drop, haematuria (±bladder catheterization), ultrasound finding of a bleeding, need for (non)surgical intervention and/or transfusion) after the biopsy was correlated to each test. Male–female ratio was 2:1. 50% had a surveillance biopsy at either three or 12 months. Around 17% (had) used acetylsalicylic acid ( ASA ) prebiopsy. Of 17 bleeding events, one subject needed a transfusion. Most bleeding events were Hb reductions over 1 mmol/l and all resolved uneventful. BT , PFA ‐100, MEA and MPV did not predict a bleeding outcome; prior ASA use however could (odds ratio 3.19; 95%‐ CI 1.06 to 9.61). Diagnostic performance data and Bland–Altman analysis showed that BT could not be substituted by PFA ‐100. ASA use was the best determinant of bleeding after kidney biopsy. Routine haemostasis testing prebiopsy has no added value.