Read on TwitterWould you biopsy a patient with aspirin exposure?
Bleeding complication rates are low, with less than 2% of patients requiring transfusion and less than 0.5% requiring an intervention to control the bleeding.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚠️" title="Warnsignal" aria-label="Emoji: Warnsignal">These complication rates are higher in hospitalized patients and those with AKI. https://cjasn.asnjournals.org/content/15/11/1595">https://cjasn.asnjournals.org/content/1...
But not every patient has the same risk of bleeding https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">
Risk factors include anemia, thrombocytopenia, frailty index, obesity, comorbidities, and kidney function. https://cjasn.asnjournals.org/content/15/11/1587">https://cjasn.asnjournals.org/content/1...
Risk factors include anemia, thrombocytopenia, frailty index, obesity, comorbidities, and kidney function. https://cjasn.asnjournals.org/content/15/11/1587">https://cjasn.asnjournals.org/content/1...
Aspirin is one of the most widely used antiplatelet drugs worldwide - approx. 40.000 tones are produced annually worldwide. https://abs.twimg.com/emoji/v2/... draggable="false" alt="😮" title="Gesicht mit offenem Mund" aria-label="Emoji: Gesicht mit offenem Mund">
https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts">Historically aspirin exposure has been considered a contraindication for percutaneous kidney biopsy. https://www.aspirin-foundation.com/history/ ">https://www.aspirin-foundation.com/history/&...
@SIRspecialists recommendation is to withhold the drug for at least five days before the biopsy, but this is far from consensual and based on expert opinion. https://www.jvir.org/article/S1051-0443(12)00297-7/fulltext">https://www.jvir.org/article/S...
Our own @jennifer_s_lees analyzed 2563 biopsies - 327 reported aspirin use.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚠️" title="Warnsignal" aria-label="Emoji: Warnsignal">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">https://academic.oup.com/ckj/artic...
In another @NDTsocial study, 1120 biopsies were retrospectively analyzed - 75 patients were kept on aspirin.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚠️" title="Warnsignal" aria-label="Emoji: Warnsignal">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">https://academic.oup.com/ndt/artic...
Aspirin use within 3 days of the biopsy is associated with an increased bleeding risk, mainly with high doses (325 mg).
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚠️" title="Warnsignal" aria-label="Emoji: Warnsignal">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/ ">https://pubmed.ncbi.nlm.nih.gov/30995091/...
However, the decision to stop aspirin is not risk-free.
This is partly explained by rebound phenomena, where prothrombogenic forces (such as thromboxane synthesis) are bolstered after aspirin discontinuation.https://abs.twimg.com/emoji/v2/... draggable="false" alt="🫀" title="Anatomical heart" aria-label="Emoji: Anatomical heart">
The benefit of minimizing bleeding complications must be weighed against the increased CV risk.https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚖️" title="Waage" aria-label="Emoji: Waage"> https://pubmed.ncbi.nlm.nih.gov/1825534/ ">https://pubmed.ncbi.nlm.nih.gov/1825534/&...
The benefit of minimizing bleeding complications must be weighed against the increased CV risk.
Real-world data from @scotrenalbiopsy was presented in #ERAEDTA20 by @mcq_emily showing that it is safe to continue aspirin.
Also, there is an x3 increase risk of thrombosis in ~10 days if the aspirin is stoppedhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🤯" title="Explodierender Kopf" aria-label="Emoji: Explodierender Kopf"> https://twitter.com/ERAEDTA/status/1270014236589162497?s=20">https://twitter.com/ERAEDTA/s...
Also, there is an x3 increase risk of thrombosis in ~10 days if the aspirin is stopped
So what should we do?
#Individualizehttps://abs.twimg.com/emoji/v2/... draggable="false" alt="⚖️" title="Waage" aria-label="Emoji: Waage">
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.https://abs.twimg.com/emoji/v2/... draggable="false" alt="👍" title="Daumen hoch" aria-label="Emoji: Daumen hoch">
#Individualize
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.
A special thanks to @mic21892, who helped with the literature review and to the whole @eraedta #SoMe team.
Thank you for your time and we hope this will help you make better clinical decisions in the futurehttps://abs.twimg.com/emoji/v2/... draggable="false" alt="😉" title="Zwinkerndes Gesicht" aria-label="Emoji: Zwinkerndes Gesicht">
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Thank you for your time and we hope this will help you make better clinical decisions in the future
#tweetorial #tweetorialERA #medtwitter
