Bleeding after liver biopsy does not correlate with indices of peripheral coagulation

Abstract

Contraindications for percutaneous liver biopsy are often derived arbitrarily from coagulation status of peripheral blood, but no objective data are available on the duration of bleeding from the site of liver biopsy. "Liver bleeding time" (LBT) was measured after liver biopsy had been performed at laparoscopy in 200 consecutive patients using a 1.8-mm-diameter Menghini needle. LBT was then analyzed in relation to prothrombin time, platelet count, whole blood clot time, length of biopsy cylinder, and liver histopathology. There was no correlation among any of these variables. The average LBT was 4 min 37 sec +/- 3 min 48 sec (SD). In 10 patients LBT was prolonged over 12 min (mean +/- 2 SD), but their clotting indices were not different from those of other patients. Bleeding could be stopped easily by compression if necessary. This lack of correlation may be explained by the high concentration of clotting factors in hepatic parenchyma and by mechanical compression of the needle track by the elastic tissue in the liver. It is concluded that indices of coagulation in the peripheral blood used in this study are unreliable guides of the risk of bleeding after liver biopsy and, hence, are of limited value in determining contraindications to this procedure.