title: Evaluation of risk factors for bleeding after liver biopsy in children.
abstract: OBJECTIVE
  Acetylsalicylic acid is used in liver-transplanted children to prevent thrombosis of the hepatic artery. We evaluated whether acetylsalicylic acid and other risk factors were associated with bleeding after percutaneous liver biopsy.
  
  
  METHODS
  Medical charts, laboratory results, imaging studies, and anesthesia charts of 275 ultrasound-guided liver biopsy procedures in 190 children were reviewed. A total of 178 biopsies were performed on native livers and 97 on transplanted livers.
  
  
  RESULTS
  Three major and 28 minor bleeding incidents were found. The mortality rate was 0%. Acetylsalicylic acid had been given the last 5 days before 55 of the biopsy procedures and no increased risk of bleeding was found (odds ratio 0.96 [0.37-2.26]; P = 1.00). Low-molecular-weight heparin and biopsies from focal lesions were risk factors for bleeding complications. Acute liver failure was associated with increased risk for major complications (odds ratio 26.1 [3.3-205]; P = 0.01) and was a risk factor for major bleeding. Postbiopsy ultrasound the day after the procedure (n = 266 [96% of 275 biopsies]) revealed minor bleeding after 7.1% of the biopsies and after 2.6% of the ultrasounds revealed unsuspected bleeding, but none of these required intervention.
  
  
  CONCLUSIONS
  Ultrasound-guided liver biopsy in children is a procedure with a low rate of major complications and a high rate of minor bleeding not requiring intervention. Treatment with low-dose acetylsalicylic acid did not increase bleeding incidence or total complication rate. Low-molecular-weight heparin and biopsies from focal lesions were risk factors for bleeding complications. Routine ultrasound the day after the procedure did not change handling of the patients.
authors.affiliation: Department of Pediatric Research, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Birgitte H
authors.initials: BH
authors.lastname: Westheim
authors.forename: Anniken B
authors.initials: AB
authors.lastname: Østensen
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Aagenæs
authors.forename: Truls
authors.initials: T
authors.lastname: Sanengen
authors.forename: Runar
authors.initials: R
authors.lastname: Almaas
mesh_terms: D000293:Adolescent; D001241:Aspirin / Q000009:adverse effects; D001706:Biopsy / Q000009:adverse effects; D001778:Blood Coagulation Disorders / Q000150:complications; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006454:Hemoglobins / Q000378:metabolism; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology*; D017114:Liver Failure, Acute / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications*; D016031:Liver Transplantation / Q000473:pathology*; D008297:Male; D016017:Odds Ratio; D012044:Regression Analysis; D012307:Risk Factors; D018084:Ultrasonography, Interventional
chemical_list: D005343:Fibrinolytic Agents; D006454:Hemoglobins; D006495:Heparin, Low-Molecular-Weight; D001241:Aspirin