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@HDiniz_ 
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?
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.
These complication rates are higher in hospitalized patients and those with AKI. https://cjasn.asnjournals.org/content/15/11/1595
These complication rates are higher in hospitalized patients and those with AKI. https://cjasn.asnjournals.org/content/15/11/1595
But not every patient has the same risk of bleeding 
Risk factors include anemia, thrombocytopenia, frailty index, obesity, comorbidities, and kidney function. https://cjasn.asnjournals.org/content/15/11/1587
Risk factors include anemia, thrombocytopenia, frailty index, obesity, comorbidities, and kidney function. https://cjasn.asnjournals.org/content/15/11/1587
Aspirin is one of the most widely used antiplatelet drugs worldwide - approx. 40.000 tones are produced annually worldwide. 
Historically aspirin exposure has been considered a contraindication for percutaneous kidney biopsy. https://www.aspirin-foundation.com/history/
Historically aspirin exposure has been considered a contraindication for percutaneous kidney biopsy. 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
Our own @jennifer_s_lees analyzed 2563 biopsies - 327 reported aspirin use.
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
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
In another @NDTsocial study, 1120 biopsies were retrospectively analyzed - 75 patients were kept on aspirin.
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
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 within 3 days of the biopsy is associated with an increased bleeding risk, mainly with high doses (325 mg).
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/
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/
But if aspirin use poses a risk factor for bleeding, even if it is small, one could argue for mandatory preprocedural withdrawal However, the decision to stop aspirin is not risk-free.
Aspirin withdrawal may precede up to 10,2% of acute cardiovascular syndromes, including acute coronary syndromes, acute cerebrovascular events, and acute peripheral arterial syndromes. https://pubmed.ncbi.nlm.nih.gov/15836656/
This is partly explained by rebound phenomena, where prothrombogenic forces (such as thromboxane synthesis) are bolstered after aspirin discontinuation.
The benefit of minimizing bleeding complications must be weighed against the increased CV risk. https://pubmed.ncbi.nlm.nih.gov/1825534/
The benefit of minimizing bleeding complications must be weighed against the increased CV risk.
https://pubmed.ncbi.nlm.nih.gov/1825534/
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 stopped
https://twitter.com/ERAEDTA/status/1270014236589162497?s=20
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
Also, the #KHACARI guidelines recommend stopping aspirin at least 3 days before in low CV risk patients and continuing aspirin in high CV risk patients. https://onlinelibrary.wiley.com/doi/full/10.1111/nep.13662
So what should we do?
#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.
#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 future
#tweetorial #tweetorialERA #medtwitter
Thank you for your time and we hope this will help you make better clinical decisions in the future
#tweetorial #tweetorialERA #medtwitter
