title: Is it necessary to stop antiplatelet agents before a native renal biopsy?
abstract: BACKGROUND
  The practice of advising patients to stop antiplatelet agents before an elective renal biopsy is widespread. The aim of this study was to compare the rate of bleeding complications in two centres that have different policies regarding the ongoing use of antiplatelet agents in patients undergoing an elective renal biopsy. Neither centre routinely checks bleeding time before renal biopsy. A secondary aim, therefore, was to compare complication rates from this cohort with those reported in the literature where screening for prolonged bleeding time is standard practice.
  
  
  METHODS
  A retrospective study of 1120 biopsies performed by nephrologists under direct ultrasound guidance in the two renal units in Glasgow, Scotland (Jan 2000 to May 2007) was undertaken. Antiplatelet agents were stopped 5 days before biopsy in one centre but continued in the other. Bleeding time was not measured before biopsy and pro-coagulants were not routinely administered. Major bleeding was defined as the need for blood transfusion, surgical or radiological intervention. Minor bleeding was defined as an >or=1.0 g/dL fall in haemoglobin following biopsy without the need for transfusion or intervention.
  
  
  RESULTS
  Haemoglobin fell by >or=1.0 g/dL in 221 (19.7%) patients. There were 21 (1.9%) major bleeding complications. No patient died or required nephrectomy. Gender, advancing age or worse renal impairment was not associated with an increased likelihood of bleeding. Bleeding complications in 75 patients continuing antiplatelet agents were compared with those occurring in 60 patients whose antiplatelet agents were discontinued. Minor complications were commoner in the first group (31.0 versus 11.7%; P = 0.008), though there was no difference in the rate of major complications.
  
  
  CONCLUSIONS
  The risk of major bleeding following a native renal biopsy under ultrasound guidance is low. Stopping antiplatelet agents before biopsy was associated with a lower rate of minor complications but there was no difference in the rate of major complications. Complication rates compare favourably with other published series in which bleeding time was checked and corrected.
authors.affiliation: Renal Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom. bmackinnon@hotmail.com
authors.forename: Bruce
authors.initials: B
authors.lastname: Mackinnon
authors.forename: Emily
authors.initials: E
authors.lastname: Fraser
authors.forename: Keith
authors.initials: K
authors.lastname: Simpson
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Fox
authors.forename: Colin
authors.initials: C
authors.lastname: Geddes
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects*; D001760:Bleeding Time; D015331:Cohort Studies; D000075202:Contraindications; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D010975:Platelet Aggregation Inhibitors