Native kidney biopsy plays a crucial role in the diagnosis of many conditions and, while generally safe, can be associated with bleeding complications.
Would you biopsy a patient with aspirin exposure?
These complication rates are higher in hospitalized patients and those with AKI. https://cjasn.asnjournals.org/content/15/11/1595
Background and objectives Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complica...https://cjasn.asnjournals.org/content/15/11/1595
Risk factors include anemia, thrombocytopenia, frailty index, obesity, comorbidities, and kidney function. https://cjasn.asnjournals.org/content/15/11/1587
Background and objectives The risk of major bleeding after percutaneous native kidney biopsy is usually considered low but remains poorly predictable. The aim of the study was to assess the risk of...https://cjasn.asnjournals.org/content/15/11/1587
Historically aspirin exposure has been considered a contraindication for percutaneous kidney biopsy. https://www.aspirin-foundation.com/history/
The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from both the private and academic...https://www.jvir.org/article/S1051-0443(12)00297-7/fulltext
No association was found between aspirin use and major bleeding but there was an increased risk for major bleeding in indication biopsies vs elective procedures. https://academic.oup.com/ckj/article/10/4/573/3072619
AbstractBackground. Bleeding is a recognized complication of native percutaneous renal biopsy. This study aimed to describe the incidence of major bleeding aftehttps://academic.oup.com/ckj/article/10/4/573/3072619
The risk of Hb drop > 1g/dL was significantly higher but there was no association between aspirin use and major bleeding. https://academic.oup.com/ndt/article/23/11/3566/1936619
Aspirin use on the day of the biopsy is the most important factor for bleeding complications (OR 12,4 p-value < 0,001). https://pubmed.ncbi.nlm.nih.gov/30995091/
OBJECTIVE. The purpose of this study is to report the frequency of major bleeding after percutaneous image-guided core biopsy and its association with aspirin usage and duration of prebiopsy aspirin...https://pubmed.ncbi.nlm.nih.gov/30995091/
However, the decision to stop aspirin is not risk-free.
Only if low-dose aspirin may cause bleeding risks with increased mortality or sequels comparable with the observed cardiovascular risks after aspirin withdrawal, it should be discontinued prior to an...https://pubmed.ncbi.nlm.nih.gov/15836656/
The benefit of minimizing bleeding complications must be weighed against the increased CV risk. https://pubmed.ncbi.nlm.nih.gov/1825534/
Also, there is an x3 increase risk of thrombosis in ~10 days if the aspirin is stopped https://twitter.com/ERAEDTA/status/1270014236589162497?s=20
This KHA‐CARI Guideline laid down principles for the care of patients undergoing kidney biopsy, and provides management guidelines from with‐holding of antiplatelet and anticoagulant agents, applic...https://onlinelibrary.wiley.com/doi/full/10.1111/nep.13662
In patients with high cardiovascular risk, in whom the risks of suspending aspirin therapy outweigh the increase in bleeding risk, a kidney biopsy may still be performed safely, especially if it is an elective procedure.
Thank you for your time and we hope this will help you make better clinical decisions in the future
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