title: The Timing and Presentation of Major Hemorrhage After 18,947 Image-Guided Percutaneous Biopsies.
abstract: OBJECTIVE
  The objective of our study was to characterize the temporal and clinical manifestation of major bleeding events after biopsy to guide clinicians in the institution of appropriate surveillance.
  
  
  METHODS
  We performed a retrospective review of percutaneous image-guided biopsies performed between September 1, 2005, and May 31, 2012, including 18,947 biopsy events. According to routine protocol, follow-up telephone calls were made to patients 24 hours after biopsy, and chart review was performed 3 months after biopsy. Bleeding complications were defined using the Common Terminology Criteria for Adverse Events (CTCAE, version 4.0) established by the National Cancer Institute. In patients with a grade 3 or greater bleeding complication, a retrospective chart review was performed to characterize the details of the complication including the timing of the complication and the primary clinical presentation of the event.
  
  
  RESULTS
  Grade 3 hemorrhage was associated with 64 of 18,947 (0.3%) procedures, and there were three deaths associated with the biopsy event (0.02% or ≈ 2/10,000). Hemorrhage was most commonly associated with biopsy of a native kidney (17/1407, 1.2%). Twenty patients (31%) presented with a bleeding complication within 1 hour of biopsy. Twenty-seven patients (42%) presented within 2 hours of biopsy. Fifty-two patients (81%) presented within 24 hours, and the remaining 12 patients (19%) presented more than 24 hours after biopsy. Pain was the most common presentation of patients with bleeding complications, occurring in 39 (61%) patients.
  
  
  CONCLUSIONS
  The incidence of major bleeding after percutaneous biopsies is very low, but delayed complications occur more frequently than anticipated. Pain is the most common clinical presentation of major bleeding complications.
authors.affiliation: 1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Atwell
authors.affiliation: 2 Center for Diagnostic Imaging, Alexandria, MN.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Spanbauer
authors.affiliation: 1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
authors.forename: Brendan P
authors.initials: BP
authors.lastname: McMenomy
authors.affiliation: 1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Stockland
authors.affiliation: 1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
authors.forename: Gina K
authors.initials: GK
authors.lastname: Hesley
authors.affiliation: 3 Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Schleck
authors.affiliation: 3 Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.affiliation: 1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Welch
mesh_terms: D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D009626:Terminology as Topic; D013997:Time Factors
keywords: CT; biopsy; complication; hemorrhage; ultrasound